Breast cancer is the second leading cause of cancer death in women. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea. The purpose of the study is to analyze the results of breast reconstruction using free transverse rectus abdominis myocutaneous(TRAM) flap and to suggest the operative technique for more satisfactory results. 19 patients underwent immediate breast reconstruction from 1990 to 1998, and we experienced 2 cases of bilateral immediate reconstruction of breasts following mastectomy. We have performed the free TRAM flaps based on the deep inferior epigastric vessels using microvascular technique. TRAM flap included very small portion of rectus sheath and muscle-so called muscle sparing technique. So it reduced markedly donor site morbidity. The postoperative course of these cases was uneventful with minor complication. The free TRAM flap was an excellent method of immediate breast reconstruction using autogenous tissue and provided satisfactory outcome. The goals of the immediate breast reconstruction after mastectomy are to restore body image, to achieve near normal shape of breast, and to reduce the complications. This paper represents our experience of immediate breast reconstruction using free TRAM flap, and technical options to get more satisfactory result and reduce the complications. We think this method could be regarded as the first choice for immediate breast reconstruction.
Body Image ; Breast Neoplasms ; Breast* ; Female ; Humans ; Korea ; Mammaplasty* ; Mastectomy ; Rectus Abdominis* ; Tissue Donors

PURPOSE: To describe the appearance and average thickness of the internal anal sphincter with anal endosonography in healthy Korean adults. MATERIAL AND METHODS: 184 subjects(male: 96, female: 88) with no history of anorectal disease or surgery were studied with anal endosonography. The average thickness of internal sphincter was meas ured at the mid-anal canal. For the internal sphincter, which is often asymmetric, the thickness of each 4 part(12, 3, 6 and 9 o'clock direction) were measured in left lateral decubitus position. RESULTS: The anal wall was well visualized in 5 layers(mucosa, submucosa, internal anal sphincter, intersphincteric plane, external anal sphincter) with anal endosonography. The anal endosonogram showed the internal anal sphincter as a homogenous, well-defined, hypoechoic, circular band, and slightly asymmetric. The average thickness of the internal anal sphincter in the area of mid-anal portion was 2.0 0.3 mm(range: 1~3 mm). There was no sexual difference; however, a significant positive correlation with age was found in average thickness of the internal anal sphincter. The correlation with lean body mass was not found. CONCLUSION: The internal anal sphincter is well-visualized, best defined structure by anal endosonography. Average thickeness of the sphincter in Korean appeared to be the same as in the Western.
Adult* ; Anal Canal* ; Endosonography ; Female ; Humans

PURPOSE: This study aimed to investigate job satisfaction, organizational commitment and turnover intention among male nurses in South Korea. METHODS: Data were collected in May, 2013 and a total of 150 male hospital nurses participated in this study. Job satisfaction, organizational commitment and turnover intention were measured using a structured questionnaire. Collected data were analyzed using SPSS/WIN 20.0 for windows. RESULTS: There were statistically significant correlations between job satisfaction and organizational commitment (r=.74, p<.001), job satisfaction and turnover intention (r=-.56, p<.001), and organizational commitment and turnover intention (r=-.69, p< .001). There was a statistically significant difference in job satisfaction of participants according to education, work unit, and salary. Organizational commitment showed significant difference according to age, education, work unit, and salary. Turnover intention was significantly different according to duration of employment in the hospital, and salary. The most influential factor for turnover intention was organizational commitment (beta=-.69, p<.001). This factor accounted for 47.8% of the variance in turnover intention. CONCLUSION: The results of this study indicate that to reduce turnover intention for men in nursing, it is necessary to increase job satisfaction, and organizational commitment.
Education ; Employment ; Humans ; Intention* ; Job Satisfaction* ; Korea ; Male ; Nurses, Male* ; Nursing ; Surveys and Questionnaires ; Salaries and Fringe Benefits

No abstract available.
Pulmonary Atelectasis*

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on pressure ulcers which is a major, functionally-limiting medical problem impairing quality of life for many people each year. METHOD: Seven patients who had stage 3 pressure ulcers were enrolled for the study. Each patient was treated with 6 sessions of low-energy (0.10~0.15 mJ/mm2, 1,000 impulses) ESWT. The length, width, depth and soft tissue biopsy of pressure ulcers were evaluated every 2 weeks for 6 weeks. RESULTS: The length, width and depth decreased significantly after 2 weeks of ESWT application. Healthy granulation tissue was formed. Soft tissue biopsy revealed increased the number and size of capillaries and decreased inflammatory cells in treated case. CONCLUSION: ESWT promoted wound healing and revealed favorable histological changes in pressure ulcers. We suggest that ESWT can be used for the safety and effective management of pressure ulcer.
Biopsy ; Capillaries ; Granulation Tissue ; Humans ; Pressure Ulcer ; Quality of Life ; Shock ; Wound Healing

Laser-assisted in situ keratomileusis(LASIK) theoretically provide less corneal haze and more accurate correction. In the LASIK. however, photo refractive keratectomy(PRK) will be done on the stromal surface exposed after removal of the 130 micrometer thick lenticule. Deep stromal ablation after removal of 130 micrometer thick lenticule may result in endothelial damage. We observed endothelial cytoskeletal changes after deep PRK to evaluate the endothelial safety in rabbit. PRK was performed on the rabbit cornea without removing the epithelium with VISX 20/20 (160mj/cm2/pulse, 5Hz) to correct 6, 9, 12, and 15 diopters of myopia by single or multiple zone. Seven days after ablation, the rabbit was euthanized, corneas excised and endothelial F-actin was stained with NBD-phallacidin to demonstrate any cytoskeletal changes. No F-actin changes were observed in corneas after either single zone, 6 or 9 diopter correction, and multiple zone ablation. However, 12 diopters or higher correction in a single zone resulted in pleomorphism and polymegethism on focal areas. In the LASIK procedure, the endothelium might be damaged and further investigation for the endothelial preservation during the procedure is needed in human.
Actins* ; Cornea ; Endothelium ; Endothelium, Corneal ; Epithelium ; Humans ; Keratomileusis, Laser In Situ ; Myopia ; Photorefractive Keratectomy

p53 is a tumor suppressor gene product identified in a wide range of tumor including colorectal carcinoma. Genetic alterations in the p53 tumor suppressor gene are common in human colorectal carcinoma. bcl-2 is a protooncogene that inhibits apoptosis. The products of mutant p53 gene and bcl-2 have been associated with prognosis in several malignancies including colorectal carcinomas. This study was undertaken to evaluate values of p53 and bcl-2 oncoproteins as prognostic factors relative to clinicopathological factors and correlation of their expression. Analyses were made on achieval pathologic tissues of 80 patients with colorectal carcinomas including 34 patients able to follow-up over 5 years. The oncoproteins were localized using commercially available monoclonal antibodies:DO-7 for p53, clone124 for bcl-2. Expression of bcl-2 was cytoplasmic, whereas nuclear p53 expression was localized in carcinoma cells. The patients were 17 to 83 years of age. The expression of p53 and bcl-2 was determined respectively in 30 (37.5%) and 21 (26.3%)cases. The expression of p53 nuclear expression was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and tumor recurrence. The cytoplasmic expression of bcl-2 was not correlated with tumor location, size, histologic grade, Duke's classification, regional lymph node metastasis and recurrence. Univariate analysis showed that patients with p53 nuclear expression were not associated with poorer overall survival than patients with p53 negative, and also showed in patients with bcl-2 expression. The expression of p53 did not affect to that of bcl-2. We concluded that the p53 nuclear and bcl-2 cytoplasmic expression were not independent prognostic factors in colorectal carcinomas. Evidence of reciprocity of bcl-2 and p53 expression was not found.
Apoptosis ; Classification ; Colorectal Neoplasms* ; Cytoplasm ; Follow-Up Studies ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Oncogene Proteins ; Prognosis ; Recurrence

There are a lots of evidences that colorectal cancer arise as a result of multiple alterations of genes. Many attempts were made to understand the role of oncogenes and suppressor genes as a prognostic indicator, recently. Although histopathologic staging of tumor is the most important prognostic factor up to now, it is not enough to be used with full confidence. Apoptosis or programmed cell death represents a deletion of damaged or natural cell mechanism. The bel-2 proto-oncogene is known as a inhibitor of apoptosis that may allow accumulation and propagation of cells containing genetic alterations. Overexpression of bcl-2 probably plays a role in colorectal carcinogenesis. The aim of this study was to determine bcl-2 and p53 expression in colorectal carcinoma in correlation with apoptosis, clinical parameters, and histopathology, and to test their prognostic significance in patient with colorectal carcinoma. The bel-2 and p53 protein were identified by immunohistochemical staining using monoclonal and polyclonal antibody. The apoptotic index was detetermined by microscopic examination of hematoxyln and rosin-stained sections at x400. The materials subiected to this study were 54 paraffin-embedded colorectal carcinomas, which were collected randomly from January of 1992 to December of 1994 at Department of Surgery, Chosun University Hospital. Of 54 cases, 21 (38.9%) and 22(40.7%) showed positive expression of bel-2 and p53 protein respectively. Mean apoptotic index(AI) was 2.99% in colorectal carcinoma. Bcl-2 expression did not correlated with p53 expression or apoptotic index. Positive expression of p53 or AI was not correlate with any other clinical and pathologic parameters. An inverse correlation was found between bel-2 expression and increased tumor stage or Iymph node metastasis (P<0.05). In conclusion, these results suggest that bcl-2 expression is significant associated with early stage in colorectal carcinoma. But bcl-2 p53 and AI can`t be a independent prognostic factor in colorectal carcinoma. Further investigations to clarity its possible role in controlling the tumor decelopment and growth of colorectal carcinoma are needed.
Apoptosis ; Carcinogenesis ; Cell Death ; Colorectal Neoplasms* ; Genes, Suppressor ; Humans ; Neoplasm Metastasis ; Oncogenes ; Proto-Oncogenes

PURPOSE: This study is to evaluate the effectiveness on patency rates of two silicone tube intubation comparing with one silicone tube intubation in endonasal dacryorhinostomy. METHODS: The 99 patients' charts were reviewed on patency rate and the cause of failure in patients with nasolacrimal duct obstruction, who had undergone endonasal DCR with two sets of silicone tube intubation. Another 100 patients who underwent endoscopic DCR with single silicone tube intubation, were enrolled in this study as the control group to compare the patency rates and the causes of failure between the two groups. RESULTS: Double silicone tube intubation group showed much higher lacrimal patency rates (89.9%) than that (84.0%) of single silicone intubation group. It seems to be due to less membrane formation (4%) at the site of internal ostium by sufficient bougination in two silicone tube intubation group compared with one silicone tube intubation group (16%). Two silicone tube intubation in endonasal DCR was more effective in preserving the lacrimal patency and avoidance of membranous obstruction at newly created nasal ostium (P=0.03). There were no significant differences in the size of nasal cavity, sex and age distributions, and postoperative cares between the two groups. CONCLUSIONS: Two silicone tube intubation can be considered to be a method of improving success rate in endonasal DCR.
Age Distribution ; Dacryocystorhinostomy* ; Humans ; Intubation* ; Membranes ; Nasal Cavity ; Nasolacrimal Duct ; Silicones*

The vagina is an infrequent site of primary sarcomas, which are less than 2% of all malignant vaginal neoplasm. The most common malignant mesenchymal tumor of the vagina is rhabdomyosarcoma, but leiomyosarcoma is rare type tumor of the vagina. Microscopically, spinle cells with pleomorphic nuclei and mitotic figures were frequently noted, but cross-striations were not found in the tissue. Alpha-smooth muscle actin and desmin were positive, but sarcomeric actin was negative in the tumor cells. The authors report a case of primary leiomyosarcoma of the vagina with brief literature review.
Actins ; Desmin ; Leiomyosarcoma* ; Rhabdomyosarcoma ; Sarcoma ; Vagina* ; Vaginal Neoplasms