There has been considerable controversy over the prognosis of mucinous gastric enocarcinoma (MGC). In this study we analyzed the clinicopathologic fferences between MGC and non-mucinous gastric carcinoma (NMGC). In addition, e relationship between mucin content and other clinicopathologic variables, cluding prognosis in MGC, was also investigated. We reviewed 2118 patients th pathologically-confirmed gastric cancer who underwent gastrectomy at the partment of Surgery, Yonsei University College of Medicine, during the period tween Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric carcinoma th extracellular mucin (MGC) and 1988 patients had gastric carcinoma without tracellular mucin (NMGC). We placed the MGC patients into two groups according mucin content: mucin content involving over 50% of the tumor (dominant type, = 94) and mucin content involving less than 50% of the tumor area (partial pe, n = 36). The results were as follows: MGC was more common in males than GC. The size of the tumor in MGC (mean 5.3 cm) was larger than that of NMGC ean 4.4 cm). The patients with MGC had a higher incidence of Borrmann type IV GC: 16.1%, NMGC: 9.9%), more frequent serosal invasion (MGC: 75.4%, NMGC: .6%), lymph-node metastasis (MGC: 75.4%, NMGC: 50.7%), and peritoneal tastasis (MGC: 10.0%, NMGC: 3.5%) than patients with NMGC. The patients with C were more advanced in stage at the time of diagnosis and had a worse overall -year survival rate (44.9%) than patients with NMGC (54.7%). However, the -year survival rate according to the stage of MGC was similar to that of NMGC. ere were no significant differences between the mucin content and other thologic variables, including prognosis, i.e. similar biologic behavior tween dominant type MGC and partial type MGC. In conclusion, we suggest that C was more frequently diagnosed in advanced stage than NMGC with a poorer ognosis and that it is reasonable to consider the carcinoma with mucin content volving more than 30% of the tumor area as MGC.
Adenocarcinoma/pathology ; Adenocarcinoma/metabolism ; Adenocarcinoma, Mucinous/pathology* ; Adenocarcinoma, Mucinous/metabolism* ; Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Male ; Middle Age ; Mucins/metabolism ; Neoplasm Staging ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/metabolism*

OBJECTIVES: The study is to test reliability and validity of the Korean version of spiritual well being scale which is devised by Paloutzian and Ellison. METHODS: The spiritual well being scale was translated into Korean by two psychiatrist and 131 Christians rated the Korean version of spiritual well being scale. For test-retest reliability, 80 telephone counsellor trainee rated it again after one week interval and statistical analysis was done with the collected data. RESULT: Correlation coefficients were regarded to have good test-retest reliability. Cronbach alpha value of total score, and religious well being subscale and existential well being subscale were significantly high. Among demographic factors, health(healthier) factors, is related with significantly high score of spiritual well-being scale(SWS). Period(over 30year) of christianity showed significant discriminative score of SWS. Factor analysis for validity showed 5 subgroups which were correlated with religious well-being scale(RWS) and existential well-being scale(EWS). 1st subgroup of RWS is related with educational factor, 2nd subgroup of RWS is related with health foactor, 3rd subgroup of RWS is related with personal relationship with God especially, 4th subgroup of EWS is related with health factor and 5th subgroup of EWS is related with reality oriented view. CONCLULSION: The Korean version of SWS which is consisted of RWS and EWS was proved to be a reliable and valid instrument of assessment of spirituality.
Christianity ; Demography ; Humans ; Psychiatry ; Reproducibility of Results* ; Spirituality ; Telephone

BACKGROUND: Rifabutin (ansamycin) is a spiro-piperidyl rifamycin, which is highly active against Mycobacterium tuberculosis. It has been found that some clinical isolates of tubercle bacilli that are resistant to rifampicin are susceptible to rifabutin, with some patients with multi-drug resistant pulmonary tuberculosis having shown favorable clinical and bacteriological responses to the rifabutin. This study was conducted to find the proportion of rifabutin- susceptible strains among rifampicin-resistant isolates from Korean MDR-TB patients, and investigate the presence of specific rpoB mutations, which may confer resistance to rifampicin, but not to rifabutin. METHODS: 201 rifampicin-resistant and 50 pan-susceptible M. tuberculosis isolates were randomly selected for this study. The isolates were retested at rifampicin and rifabutin concentrations of 0, 20, 40 and 80 microgram/ml, respectively. The isolates that grew at and/or over a rifabutin concentration of 20 microgram/ml were judged rifabutin-resistant. The rpoB gene was extracted from the isolates, and then amplified for direct sequencing to investigate specific rpoB mutations that conferred rifabutin- susceptibility but rifampicin-resistance. RESULTS: Out of the 201 rifampicin-resistant M. tuberculosis, 41 strains (20.4%) were susceptible to rifabutin using the absolute concentration method on Lowenstein-Jensen media. The rpoB mutation types that showed susceptibility to rifabutin were Leu511Pro, Ser512Arg, Gln513Glu, Asp516Ala, Asp516Gly, Asp516Val, Asp516Tyr, Ser522Leu, His526Asn, His526Leu, His526Cys, Arg529Pro and Leu533Pro. A reverse hybridization technique was able to detect 92.5% of the rifabutin-susceptible isolates, with a specificity of 96.1% among 195 M. tuberculosis isolates with the rpoB mutation. CONCLUSIONS: Around 20% of the rifampicin-resistant isolates in Korea showed susceptibility to rifabutin, which was associated with some specific mutations of rpoB. Rifabutin could be used for the treatment of MDR-TB patients, especially when drug susceptibility testing reveals susceptibility to rifabutin.
Humans ; Korea ; Mycobacterium tuberculosis ; Rifabutin ; Rifampin ; Tuberculosis ; Tuberculosis, Pulmonary

There has been a considerable controversy on the prognosis of the mucinous gastric adenocarcinoma(MGC). In this study we analyzed the clinicopathologic differences between MGC and non-mucinous gastric carcinoma(NMGC). In addition, the relationship between mucin content and other clinicopathologic variables, including prognosis in MGC was examined. We reviewed 2118 patients with pathologically confirmed gastric cancer who had underwent gastrectomy at the department of surgery of Yonsei University College of Medicine, during the period between Jan. 1987 and Dec. 1993. Among them, 130 patients had gastric cancer with extracellular mucin(MGC) and 1988 patients had gastric carcinoma without extracellular mucin(NMGC). We studied the MGC patients into two groups according to mucin content: mucin content involving over 50% of the tumor(dominant type, n=94) and mucin content involving less than 50% of the tumor area(partial type, n=36). The results are as follows: The MGC was more common in male then NMGC. The size of tumor in MGC was larger than that of NMGC. The patients with MGC had higher incidence of Borrmann type IV, more frequent serosal invasion, lymph nodes metastasis and peritoneal metastasis than the patients with NMGC. The patients with MGC had more advanced stage at the time of diagnosis and worse overall 5-year survival rate than the patients with NMGC. But the 5-year survival rate according to the stage of MGC was similar to that of NMGC. There were no significant differences between the mucin content and other pathologic variables including prognosis. So we suggested that MGC has worse prognosis than NMGC and it is reasonable to consider the carcinoma with mucin content involving less than 50% of the tumor area as MGC.
Adenocarcinoma* ; Diagnosis ; Gastrectomy ; Humans ; Incidence ; Lymph Nodes ; Male ; Mucins* ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms ; Survival Rate

Oxygen therapy is clear benefit in the treatment of tissue hypoxia, but high concentrations and long term exposures of oxygen carry the risks of detrimental physiologic changes and tissue damages. Tissue damages involve decreased surfactant production,alveolar edema, and alveolar hemorrhage. In spite of these damage, diagnosis of oxygen toxicity is difficult in many clinical settings. In this study, we measured lung compliance to evaluate the oxygen toxicity in 60 white rat of 100-150 g body weight Rats were divided into 6 groups. Group I was control graup, exposed to room air, group II -group V were exposed to 100% oxygen, group II for 24 hours, group IlI for 48 hous, group IV for 72 hours, and group V for 96 hours. Group VI was exposed to oxygen in serial as 30% oxygen for 24 hours, 60% oxygen for 24 hours and then 100% oxygen for 96 hours. After oxygen exposure we obseved changes of lung compliance and pathologic findings, compliance of group V was 15.94 mL/cmH2O significantly lower than that of eontrol group (p<0.05) and lung weight of group V was 2.16 g/100 g heavier than the other groups (p<0.05). Although we found oxygen tolerance was developed in group V, we could not differentiate the degree of pathologic damage cauesd from oxygen toxicity by pathologic findings. We concluded that the measurement of lung compliance is valuable in diagnosis of oxygen toxicity and thus in reducing lung damages.
Animals ; Anoxia ; Body Weight ; Compliance ; Diagnosis ; Edema ; Hemorrhage ; Lung Compliance* ; Lung* ; Oxygen* ; Rats*

Oxygen therapy is clear benefit in the treatment of tissue hypoxia, but high concentrations and long term exposures of oxygen carry the risks of detrimental physiologic changes and tissue damages. Tissue damages involve decreased surfactant production,alveolar edema, and alveolar hemorrhage. In spite of these damage, diagnosis of oxygen toxicity is difficult in many clinical settings. In this study, we measured lung compliance to evaluate the oxygen toxicity in 60 white rat of 100-150 g body weight Rats were divided into 6 groups. Group I was control graup, exposed to room air, group II -group V were exposed to 100% oxygen, group II for 24 hours, group IlI for 48 hous, group IV for 72 hours, and group V for 96 hours. Group VI was exposed to oxygen in serial as 30% oxygen for 24 hours, 60% oxygen for 24 hours and then 100% oxygen for 96 hours. After oxygen exposure we obseved changes of lung compliance and pathologic findings, compliance of group V was 15.94 mL/cmH2O significantly lower than that of eontrol group (p<0.05) and lung weight of group V was 2.16 g/100 g heavier than the other groups (p<0.05). Although we found oxygen tolerance was developed in group V, we could not differentiate the degree of pathologic damage cauesd from oxygen toxicity by pathologic findings. We concluded that the measurement of lung compliance is valuable in diagnosis of oxygen toxicity and thus in reducing lung damages.
Animals ; Anoxia ; Body Weight ; Compliance ; Diagnosis ; Edema ; Hemorrhage ; Lung Compliance* ; Lung* ; Oxygen* ; Rats*

It has been reported that dyspeptic symptoms in a minority of the patients who undergo cholecystectomy are persistent. Cholecystectomy may have a direct effect on the development of dyspeptic symptoms, predisposing the patient to increased duodenogastric reflux. Excessive reflux of noxious duodenal content into the stomach has been associated with chronic gastritis, gastric ulceration, and esophagitis. We examined 9 patients with gallstone disease who underwent laparoscopic cholecystectomy to determine the changes in the gastroesophageal reflux and the esophageal function. All the patients underwent looth standard esophageal manometry to study esophageal function and 24-hr esophageal pH monitoring to ascertain the gastroesophageal reflux the prior to at the time of, and 3 months after the laparoscopic cholecystectomy. The mean lower esophageal sphincter(LES) length, the abdominal esophageal sphincter length, and the resting pressure of LES were increased from 3.1 cm, 2.3 cm 19.9 mmHg to 3.2 cm, 2.6 cm, 22.9 mmHg, with no statistical significance. The mean sphincter function index increased from 1484 to 1888 after the operation with no statistical significance. The mean ampulitude of contraction in the upper, the middle, and the lower portions of the esophageal body, but again increased from 44.4 mmHg, 59.8 mmHg, and 87.5 mmHg to 56.7 mmHg, 84.44 mmHg, and 117.8 mmHg, respectively, after the operation. The mean DeMeester acid reflux score decreased from 13.5 to 7.0 after the operation(p=0.343). In this study, the laparoscopic cholecystectomy did not affect the lower esophageal sphincter function. However there was an increase in the amplitude and the duration of contractions in the esophageal body. Therefore, the heartburn that persists after a cholecystectomy may be an esophageal origin. We suggest that all patients with biliary symptoms, but without documented acute cholecystitis should undergo full upper gastrointestinal investigations with esophagogastroduodenoscopy and pH monitoring (especially dual channel gastric and esophageal pH moniotring) to differentiate the esophageal pathology from other origins.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Duodenogastric Reflux ; Endoscopy, Digestive System ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophagitis ; Gallstones* ; Gastritis ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Pathology ; Stomach ; Stomach Ulcer

PURPOSE: Generalized peritonitis caused by a free perforation of gastric cancer is a rare condition, which occurs in 1~4% of all gastric cancer patients. To assess the characteristics of the patients and investigate the optimal treatment of choice, the data from 51 patients previous recent 10 years were retrospectively analyzed. METHODS: Between 1988 and 1997, 51 patients underwent surgical treatment for perforated gastric cancer. The clinicopathological features and survival rates of the resected group (n=39) and the non-resected group (n=12) were analyzed. RESULTS: The incidence was 0.78% and the mean age was 57 years. The most common tumor location was in the lower 1/3 in the resected group (n=21, 53.8%) and in the upper 1/3 in the non-resected group (n=6, 50%). Borrmann type 3, the poorly differentiated type, and a positive serosa invasion were more common in both groups. Liver and peritoneal metastases were observed in 2 cases (5.2%) and 7 cases (14.3%) in the resected group, and 4 cases (33.4%), and 3 cases (25%) in the non-resected group, respectively. Resectability found in 76.5%: 27 cases of a subtotal gastrectomy and 12 cases of a total gastrectomy. A limited lymph node dissection (D0, D1) was performed in 14 cases (35.9%) and an extended dissection (D2, D3) was performed in 25 cases (64.1%). The 5-year survival rate of stage I was 80%, 40% in stage II, 14% in stage III and 0% in stage IV, and the overall 5 year survival rate was 20.5% in the resected group and 0% in the non-resected group. The depth of invasion, lymph node metastasis and tumor stage significantly influenced the survival rate of the patients. CONCLUSION: Because a perforation of the gastric cancer may develop in every stage, surgeons must take care of these patients by the same way as with non-perforation cases.
Gastrectomy ; Humans ; Incidence ; Liver ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Peritonitis ; Retrospective Studies ; Serous Membrane ; Stomach Neoplasms* ; Survival Rate

BACKGROUND: The treatment success rates in patients with tuberculosis are known to be lower in the private sector compared to the public sector. To improve treatment outcomes in the private sector we developed a public-private collaboration model for strengthening health education and case holding activities with public health nursing in the private sector. METHODS: We performed a prospective cohort study in new smear positive pulmonary tuberculosis patients treated at private hospitals, selected by non-randomization, with an intervention consisting of health education and case holding activities by specially trained public health nurses (intervention group) results were compared with cases treated without the intervention (conventional group). Physicians were asked to treat both groups routinely. The treatment outcomes of patients under treatment by the National Tuberculosis Programme were also analyzed for comparison. RESULTS: There were 172 cases each in the intervention and conventional groups. The mean age was 48.9+/-19.0 and 48.2+/-19.7 in the respective groups (p=0.66). The PHN interacted with the cases in the intervention group by initial face to face interview and telephone calls an average of 7.1+/-9.2 times during the initial six months. The intervention group showed a significantly higher treatment success rate, 91.6%, (Rate Ratio [RR]; 1.23, 95% Confidence Interval [CI]; 1.12~1.36), lower default, 3.6%, (RR; 0.31, 95% CI; 0.13~0.75) and transfer-out rate, 3.0%, (RR; 0.32, 95% CI; 0.12~0.86) than the conventional group where they were: 75.0%, 11.6%, 9.3%, respectively. The success rate was even higher than the rate (80.5%) of 1,027 cases treated in health centers (RR; 1.11, 95% CI; 1.05~1.17). Of the completed cases in the intervention group, 82.2% regarded the role of the public health nurse as very helpful. CONCLUSION: The treatment success rate, of tuberculosis patients in the private sector, was significantly improved by an intervention using a public-private collaboration model.
Cohort Studies ; Cooperative Behavior ; Health Education ; Hospitals, Private ; Humans ; Private Sector ; Prospective Studies ; Public Health Nursing ; Public Sector ; Telephone ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: The drug resistance rate in tuberculosis patients with history of chemotherapy is an important indicator of for evaluation of appropriateness of treatment regimens and compliance of patients. This study examined the long-term changes in the drug resistance rates among TB patients failed in treatment or reactivated. METHODS: The results of drug susceptibility testing data from patients registered in health centers from 1981 to 2004 were analyzed. RESULTS: The rate of resistance to isoniazid decreased from 90% to 20%, and the resistance to ethambutol decreased from 45% to 6%. The rate of resistance to rifampicin varied from 13% to 28% and the resistance to pyrazinamide was 5% to 10%. Multidrug resistance was about 2-3% lower than any rifampicin resistance rates. The second-line drug resistance was ranged from 1% to 3%. There was no difference between patients' genders. Patient numbers per 100,000 population increased with age. The regional distribution was even at 4-6 patients per 100,000 population, and drug resistance rates were significantly lower in big city areas than in small towns and rural areas. CONCLUSION: The rates of resistance of Mycobacterium tuberculosis isolated from TB patients with history of chemotherapy to isoniazid, rifampin, ethambutol, and isoniazid plus rifampin were significantly decreased during over two decades.
Compliance ; Drug Resistance ; Drug Resistance, Multiple ; Drug Therapy ; Ethambutol ; Humans ; Isoniazid ; Mycobacterium tuberculosis ; Pyrazinamide ; Rifampin ; Tuberculosis*