No abstract available.
Female ; Humans ; Marriage*

Basal cell carcinoma (BCC) is the most common skin cancer in humans. It usually develops on sun-exposed areas of the head and neck but can occur anywhere on the body. The various clinical features include nodules, ulcers, bleeding, crust, or scale. Thus, it is important to distinguish BCC from other diseases with similar clinical features. The umbilicus is one of the sun-protected sites where BCC rarely develops. Herein, we describe 71-year-old woman with umbilical BCC initially misdiagnosed as pyoderma.
Aged ; Carcinoma, Basal Cell ; Female ; Head ; Hemorrhage ; Humans ; Neck ; Pyoderma ; Skin Neoplasms ; Ulcer ; Umbilicus

BACKGROUND: This study was intended to present the importance of insight status concerning the abstinence of alcoholics. METHODS: The 214 subjects, who participated in insight improving programs during hospitalization in an alcohol treatment center, were followed up for their abstinent status during the 12 month period after discharge. The relation between their abstinence results and insight status was investigated. To find out the influence of other factors upon abstinence, stepwise multiple regression was performed over variables including disease severity, sociodemographic, therapeutic and familial features. RESULTS: The 73 individuals (34.1%) had 'no remission', 110 (51.4%) 'early full remission', and 31 (14.5%) 'sustained full remission'. The insight degree was significantly correlated with both 'initial consecutive months of sobriety'(IMS) after discharge and 'total months of sobriety'(TMS) during the follow up. The 153 subjects (71.5%) relapsed within four months after discharge, and the rate of continuous abstinence at each month differed significantly among three insight groups. On the inter group shifts during hospitalization, the abstinent months were greater in the group whose insight changed from 'poor ' to 'good insight' than the one from 'fair ' to 'good insight'. By stepwise multiple regression analysis, the higher insight scores, older age and shorter hospital days, in a decreasing order of association, the longer IMS and TMS, while absence of religion and lower MAST scores was associated only with IMS, with their overall R2 value of 18.5% and 20.8%, respectively. CONCLUSION: The insight degree was related to the length of abstinence and thus it is necessary to develop insight improving programs which can be of help to recovering patients.
Alcoholics ; Alcoholism ; Follow-Up Studies ; Hospitalization ; Humans ; Prognosis

BACKGROUND: With increased prevalence of colorectal cancer, it is important to establish the risk factors of colorectal cancer. The prevalence of the metabolic syndrome (MS) is also increasing. Insulin resistance may play an important role in the pathogenesis of MS and colorectal polyps. The aim of this study was to assess the relationship between MS and colorectal polyps. METHODS: A total 558 subjects underwent colonoscopic examination from April 2004 to July 2005 at the health promotion center of Bundang CHA Hospital. According to the National Cholesterol Education Program (NCEP) Adult Treatment Panel III definition of MS, the waist circumference, blood pressure (BP), fasting blood glucose (FBG), triglyceride (TG) and HDL cholesterol were measured. Alcohol consumption, smoking and other confounding factors were assessed by a self-administered questionnaire. RESULTS: The incidence of MS and colorectal polyps was 16.3% and 33.0%, respectively. In subjects with polyps, the number of men, smokers and drinkers were higher than in subjects without polyps. In subjects with polyps, BP, FBG and TG were also higher than in subjects without polyps. After adjustment for possible confounding factors, MS was associated with increased risk of colorectal polyps (odds ratio, 1.74; 95% confidence interval, 0.94~3.22). MS strongly increased the risk of colorectal polyps in men (odds ratio 2.19; 95% confidence interval, 1.07~4.45), but not in women. CONCLUSION: We concluded that MS is a risk factor for colorectal polyps in asymptomatic Korean adults and this suggests that insulin resistance may play an important role in the development of colorectal polyps.
Adult ; Alcohol Drinking ; Blood Glucose ; Blood Pressure ; Cholesterol ; Cholesterol, HDL ; Colorectal Neoplasms ; Education ; Fasting ; Female ; Health Promotion ; Humans ; Incidence ; Insulin Resistance ; Male ; Polyps* ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Triglycerides ; Waist Circumference ; Surveys and Questionnaires

BACKGROUND: Recently, allogeneic peripheral blood stem cell transplantation (Allo-PBSCT) instead of bone marrow transplantation (BMT) has been widely used with the benefits of an earlier recovery of blood cells and a lower incidence of graft failure because of higher CD34+ cell dose. However, recent studies suggested that the higher dose of CD34+ cells might be related to the lower survival and the higher morbidity due to chronic graft versus host disease (cGVHD). We have analyzed the impact of transplanted CD34+ cell dose on clinical outcomes in unmanipulated allo-PBSCT from HLA identical siblings. METHODS: Thirty-one consecutive adult patients with hematological diseases, who survived until at least day 90 after allo-PBSCT and were evaluable for cGVHD, were included. Peripheral blood stem cells were collected from HLA-matched sibling donors mobilized with G-CSF and/or GM-CSF. The patients were classified into a "low" or "high" CD34+ cell dose group based on whether they received less or more than a median CD34+ cell dose of 11.17X10(6)/kg, respectively. RESULTS: The median CD34+ cell dose was 11.17X10(6)/kg (range, 4.12-58.80X10(6)/kg). Acute GVHD (grade II-IV) appeared in 24 patients (77.4%) and extensive cGVHD in 14 patients (45.2%). During the follow-up (median: 340 days, range: 111-1263 days), relapses were observed in 12 patients (38.7%) and 19 patients are still alive. There was a significant difference in the incidence of extensive cGVHD (20.0% vs 68.8%, P=0.011) and relapse (60.0% vs 18.8%, P=0.029) between low and high CD34+ cell dose groups, but no difference of the incidence of acute GVHD or the days of engraftments between the two groups. The estimated survival rate was significantly different between the two groups (3 year survival rate, 31.5% vs 79.8%, P=0.022) and the patients with extensive cGVHD showed a higher survival rate than those without extensive cGVHD (55.6% vs 12.5%, P=0.013). CONCLUSION: Better survival rate was observed in high CD34+ cell dose group for alloPBSCT, while a higher incidence of extensive cGVHD was noted. The optimal dose of CD34+ cells need to be determined to minimize the morbidity related to cGVHD and to improve survival.
Adult ; Male ; Female ; Humans ; Incidence ; Bone Marrow Transplantation

BACKGROUND/AIMS: Acute promyelocytic leukemia is a distinct subtype of acute myeloid leukemia with a specific clinical and molecular presentation. Treatment of acute promyelocytic leukemia with all-trans retinoic acid or arsenic trioxide in association with anthracyclin has improved outcomes in this disease. We report the results of all-trans retinoic acid and arsenic trioxide-based treatment regimens in acute promyelocytic leukemia patients diagnosed in a single center. METHODS: Thirty-seven treatment events in 26 patients with acute promyelocytic leukemia were retrospectively reviewed. RESULTS: Complete remission was achieved in 29 (78.4%) of 37 treatment events. One-year overall survival rate and 1-year event-free survival rate were 74.3% and 66.3%, respectively. Among 16 patients treated with an arsenic trioxide-based regimen, 14 patients (87.5%) achieved complete remission. The 1-year overall survival rate and 1-year event-free survival rate were 78.4% and 69.6%, respectively. CONCLUSIONS: The short-term use of arsenic trioxide for salvage treatment of acute promyelocytic leukemia seems to be efficacious and could be a bridge to intensive chemotherapy or stem cell transplantation in terms of minimizing the risk of severe disseminated intravascular coagulation.
Arsenic ; Arsenicals ; Disease-Free Survival ; Humans ; Leukemia, Myeloid, Acute ; Leukemia, Promyelocytic, Acute ; Oxides ; Retrospective Studies ; Stem Cell Transplantation ; Survival Rate ; Tretinoin

PURPOSE: The selective spinal nerve root block is one of the preoperative diagnostic tool to identify and confirm the lesion site of primary cause of pain. The purpose of this study was to ascertain the correlation between diagnostic selective spinal nerve root blocks and outcome following surgical treatment of selected levels of both lumbar herniated intervertebral disc (HIVD) and spinal stenosis. MATERIAL AND METHOD: In a total 341 selective nerve root blocks in 169 patients who were diagnosed as lumbar HIVD and spinal stenosis from Jan. 1993 to Jun. 1997 with performed in a retrospective study, two groups of patients were chosen for this study. The result of pain change of selective nerve root block were judged by Denis' pain scale, the end-result selective spinal nerve root and operative treatment used by Kim's criteria. RESULT : 1. The end-results of selective spinal nerve root block, excellent and good results were 64 cases (67.3%) in lumbar HIVD group and 50 cases (67.5%) in spinal stenosis group. The end-results of selective spine surgery, at last follow up, excellent and good results were 82 cases (86.2%) in lumbar HIVD group and 56 cases (75.7%) in spinal stenosis group. RESULT: 2. The predictive value of selective spinal nerve root block was 68.4% in lumbar HIVD group and 74.3% in spinal stenosis group. In addition, statistical analysis with regression analysis, to show any significant correlation between the selective spinal nerve root block results and the outcome of operative treatment, especially in spinal stenosis group. CONCLUSION: The selective spinal nerve root block is one of the valuable procedure that helpful and predictors of outcome selective operative treatment of lumbar spinal stenosis.
Follow-Up Studies ; Humans ; Intervertebral Disc ; Retrospective Studies ; Spinal Nerve Roots* ; Spinal Nerves* ; Spinal Stenosis ; Spine*

Valproic acid is an effective anticonvulsant used in neurology and psychiatry. Valproic acid-induced hyperammonemic encephalopathy is an unusual complication characterized by a decreasing level of consciousness, the development of progressive confusional states and, sometimes, a coexisting increase in the frequency of seizures after the onset of valproic acid treatment. It can lead to death, but can be reversed if a swift diagnosis is made. We report the case of a 58-year-old woman with an intracerebral hemorrhage and normal liver function who presented with valproic acid-induced hyperammonemic encephalopathy. After valproic acid treatment, she developed encephalopathy and became comatose, with seizures and a markedly elevated serum ammonia level. Her neurologic manifestations and hyperammonemia improved after discontinuing the valproic acid.
Ammonia ; Cerebral Hemorrhage ; Coma ; Consciousness ; Female ; Humans ; Hyperammonemia ; Liver ; Middle Aged ; Neurologic Manifestations ; Neurology ; Seizures ; Valproic Acid

Amebic colitis is a disease revealing diverse clinical manifestations and endoscopic gross features and often confused with other types of colitis. In case of misdiagnosis as an idiopathic inflammatory bowel disease or delayed recognition of intestinal amebiasis, an undesirable outcome may occur resulting from erroneous administration of steroids or delayed antiamebic treatment. To demonstrate the pitfalls in the diagnosis and treatment of intestinal amebiasis, 3 cases of amebic colitis with atypical clinical manifestations are presented in this paper. In conclusion, despite the low sensitivities of routine stool examination for parasite and histopathologic confirmation in biopsy specimen, every effort must be made to find amebic trophozoites either in fresh stool or biopsy specimens for prompt and correct diagnosis of amebic colitis when we manage patients with chronic intestinal ulcerations, even though their clinical course and endoscopic findings are not typical of amebiasis. Moreover, following initial successful anti-amebic therapy, more careful clinical, endoscopical, and parasitological follow-up should be done for the early detection of recurrence.
Adult ; Aged ; Aged, 80 and over ; Colitis, Ulcerative/diagnosis ; Diagnosis, Differential ; Diarrhea/etiology ; Dysentery, Amebic/complications/drug therapy/*pathology ; Female ; Humans ; Inflammatory Bowel Diseases/diagnosis ; Male ; Middle Aged

BACKGROUND: The index which could predict the prognosis of critically ill patients is needed to find out high risk patients and to individualize their treatment. The APACHE III scoring system was established in 1991, but there has been only a few studies concerning its prognostic value. We wanted to know whether the APACHE III scores have prognostic value in discriminating survivors from nonsurvivors in sepsis. METHODS: In 48 patients meeting the Bones criteria for sepsis, we retrospectively surveyed the day 1 (Dl), day 2(D2) and day 3(D3) scores of patients who were admitted to intensive care unit. The scores of the sepsis survivors and nonsurvivors were compared in respect to the Dl score, and also in respect to the changes of the updated D2 and D3 scores. RESULTS: 1) Of the 48 sepsis patients, 21(43.5%) survived and 27(56.5%) died. The nonsurvivors were older(62.7+/-12.6 vs 51.1+/-18.1 yrs), presented with lower mean arterial pressure(56.9+/-26.2 vs 67.7 +/-14.2 mmHg) and showed greater number of multisystem organ failure(1.2+/-0.8 vs 0.2+/-0.4) than the survivors(p <0.05, respectively). There were no significant differences in sex and initial body temperature between the two groups. 2) The Dl score was lower in the survivors (n=21) than in the nonsurvivors (44.1 +/-14.6, 78.5+/- 18.6, p=0.0001). The D2 and D3 scores significantly decreased in the survivors (Dl vs D2, 44.1+/- 14.6: 37.9+/-15.0, p=0.035; D2 vs D3, 37.9+/-15.0: 30.1 +/-9.3, p=0.0001) but showed a tendency to increase in the nonsurvivors (Dl vs D2 (n=21), 78.5+/-18.6: 81.3+/-23.0, p=0.1337; D2 vs D3 (n=11), 68.2+/-19.3: 75.3+/-18.8, p=0.0078). 3) The D1 scores of 12 survivors and 6 nonsurvivors were in the same range of 42~67 (mean D1 score, 53.8+/-10.0 in the survivors, 55.3+/-10.3 in the nonsurvivors). The age, sex, initial body temperature, and mean arterial pressure were not different between the two groups. In this group, however, D2 and D3 was significantly decreased in the survivors(Dl vs D2, 53.3+/-10.0: 43.6+/- 16.4, p=0.0278; D2 vs D3, 43.6+/-16.4: 31.2+/-10.3, p=0.0005), but showed a tendency to increase in the nonsurvivors(Dl vs D2 (n=6), 55.3+/-10.3:66.7+/-13.9, p=0.1562; D2 vs D3 (n=4), 64.0+/- 16.4:74.3+/-18.6, p=0.1250). Among the individual items of the first day APACHE III score, only the score of respiratory rate was capable of discriminating the nonsurvivors from the survivors (5.5 +/-2.9 vs 1.9+/-3.7, p=0.046) in this group. CONCLUSION: In sepsis, nonsurvivors had higher first day APACHE III score and their updated scores on the following days failed to decline but showed a tendency to increase. Survivors, on the other hand, had lower first day score and showed decline in the updated APACHE scores. These results suggest that the first day and daily updated APACHE III scores are useful in predicting the outcome and assessing the response to management in patients with sepsis.
APACHE* ; Arterial Pressure ; Body Temperature ; Critical Illness ; Hand ; Humans ; Intensive Care Units ; Prognosis ; Respiratory Rate ; Retrospective Studies ; Sepsis* ; Survivors