OBJECTIVES: Apathy Evaluation Scale (AES) is one of the most frequently used scales to evaluate apathy. The purpose of this study was to evaluate the reliability and validity of the Korean version of the AES (K-AES) and to apply the K-AES in examining the characteristics of apathy in the Korean patients with schizophrenia. METHODS: 129 healthy people and 29 patients with schizophrenia have been evaluated using the K-AES, Physical Anhedonia Scale (PAS), Social Anhedonia Scale (SAS), and the Beck's Depression Inventory (BDI). Split-half reliability and internal consistency were evaluated and factor analysis and correlation analysis was conducted. Between-group comparison was conducted using independent sample t-tests. RESULTS: K-AES showed good reliability and validity. Factor analysis confirmed 3 factors, which represented interest and drive, initiative, self-awareness and self-assessment. Patients with schizophrenia showed significantly higher K-AES and BDI scores than the healthy group. K-AES scores in patients with schizophrenia were significantly correlated with the PAS score, but did not correlate with SAS and BDI scores. CONCLUSION: This study demonstrates the reliability and validity of the K-AES. Our findings also suggest that the K-AES may be a reliable instrument in assessing apathy as a negative symptom in patients with schizophrenia.
Anhedonia ; Apathy* ; Depression ; Factor Analysis, Statistical ; Humans ; Reproducibility of Results* ; Schizophrenia* ; Self-Assessment ; Weights and Measures

PURPOSE: There were many studies for adverse effects of carbon dioxide insufflation for laparoscopic cholecystectectomy, mainly focused on cardiovascular and respiratory system. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma & postoperative pain remains controversial. The aim of this study was to compare postoperative pain intensity between different insufflation pressures in laparoscopic cholecystecetomy. METHODS: We randomly allocated fifty four patients to 7 mmHg (LC7), 9 mmHg (LC9) and 12 mmHg (LC12) pneumoperitoneum group and examined operation time, postoperative pain intensity using visual analogue scale, amount of administered analgesics and complications prospectively. RESULTS: The characteristics of the patients were similar among groups. The procedure was successfully completed in all patients in the LC12 gruop, but in five patients of LC7 group and one patient of LC9 group the insufflation pressure was increased to 12 mmHg to complete the operation. There were no significant difference in postoperative pain scores, analgesic comsumptions among groups. There were difficulties to get a safe hemostasis and to create a adequate working space at acute cholecystitis in LC7 group. CONCLUSION: In our study, there was no superior advantage for postoperative pain when low pressure pneumoperitoneum was applied.
Analgesics ; Carbon Dioxide ; Cholecystectomy, Laparoscopic* ; Cholecystitis, Acute ; Hemodynamics ; Hemostasis ; Humans ; Insufflation* ; Pain, Postoperative* ; Pneumoperitoneum ; Prospective Studies ; Respiratory System

PURPOSE: Pancretojejunostomy leakage is the most dreaded complication after a pancratoduodenectomy. However, little is known about what causes the leakage and how to prevent it. The aim of this study was to dentify the risk factors for pancreatic leakage. This paper describes our experience of its management. METHODS: Between Aug. 1996 and Aug. 2003, 75 consecutive patients with periampullary cancer or benign disease received a pancreatoduodenectomy. The patients' clinical characterisitcs, pathological features and surgical findings were retrospectively evaluated. The patients were classified into those with major complication and rhose with no complications and the risk factors were analyzed. Pancreatic leakage, intraabdomnial fluid collection and abscess, intraabdomnial bleeding were categorized as major complications related to a pancreatic fistula. RESULTS: The postoperative mortality and morbidity rate was 2.6% and 36%, respectively. Univariate analysis showed that the pancreatic texture, pathologic diagnoses and comorbidity were significant risk factors for major complications (P= 0.003, 0.045, 0.02). Multivariate analyses revealed that the, pancreatic texture was the only significant risk factor (P=0.003). The preoperative serum albumin level and pancreatic texture were significant risk factors for pancreatic leakage (p=0.03, 0.025) and multivariate analysis showed that the pancreatic texture was also the most significant risk factor. CONCLUSION: Considering that the pancreatic texture is the most significant risk factor for a pancreatic fistula, the technical skill and experience of the surgeon appears to be important for its prevention.
Abscess ; Comorbidity ; Diagnosis ; Hemorrhage ; Humans ; Mortality ; Multivariate Analysis ; Pancreatic Fistula* ; Pancreaticoduodenectomy ; Retrospective Studies ; Risk Factors* ; Serum Albumin

The Peutz-Jeghers syndrome is an autosomal dominant disease characterized by hamartomatous polyps in the gastrointestinal tract and mucocutaneous melanin pigmentation. Although these polyps are believed to have little potential for malignancy, and the disease was believed to have a relatively benign course, it recently has been recognized that patients with this syndrome are at increased risk for the development of cancer at gastrointestinal and nongastrointestinal sites. A 33-year-old male patient was admitted because of vomiting and abdominal pain for 3 months duration. A diagnosis of Peutz-Jeghers syndrome was made 3 years ago by multiple hamartomatous polyps confined to the colon and mucocutaneous pigmentation. A barium study showed abrupt string like luminal narrowing at the 4th portion of the duodenum. On laparotomy, there was an annular constricting mass involving the serosa of duodenum with multiple metastasis to liver, so a segmental resection of small bowel followed by chemotherapy was performed. The histologic finding was adenocarcinoma.
Abdominal Pain ; Adenocarcinoma* ; Adult ; Barium ; Colon ; Diagnosis ; Drug Therapy ; Duodenum ; Gastrointestinal Tract ; Humans ; Laparotomy ; Liver ; Male ; Melanins ; Neoplasm Metastasis ; Peutz-Jeghers Syndrome* ; Phenobarbital ; Pigmentation ; Polyps ; Serous Membrane ; Vomiting

PURPOSE: Operative management of acute cholecystitis in aged patients has been shown to have relatively higher morbidity and mortality. The aim of this study was to determine appropriate management protocols for acute cholecystitis in those more than 70 years old. METHODS: From May 2003 to Dec 2009, we performed this study of patients over 70 years old that were diagnosed with acute cholecystitis (n=257). We excluded patients that had a hepatobilliary malignancy, a previous laparotomy history, secondary cholecystitis, or a high operative risk factor (n=78). Eligible participants were divided into two groups according to the first management of acute cholecystitis. One hundred two of the 179 (group A) had undergone a laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) within 48 hr after arriving at the emergency room; 77 of the 179 (group 2) had PTGBD done as the first management protocol. We divided group 2 into group C (n=47) and D (n=30) according to cholecystectomy or not. We compared clinical outcomes of the two groups. RESULTS: The mean age of patients was 77.5 years old (102 for Group A and 77 for Group B. Univariant analysis of pre-operative clinical findings between groups A and B showed a significant difference only in age and in type of acute cholecystitis, However, the pre-operative co-morbidity of group B was significantly higher than that for group A. Comparing postoperative results between groups A and C, postoperative complications, open conversion rate, and mortality after cholecystectomy were not significantly different. CONCLUSION: PTGBD could be considered as appropriate management in aged patients with acute cholecystitis. Moreover, PTGBD can reduce unnecessary cholecytectomies.
Aged ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Drainage ; Emergencies ; Gallbladder ; Humans ; Laparotomy ; Postoperative Complications ; Risk Factors

A 21-year-old woman presented gastrointestinal manifestation showing intermittent abdominal pain, nausea, and vomiting. An upper endoscopic examination showed round, elevated mucosa at the antrum of the stomach anterior wall. After CT scanning, a huge degenerated gastrointestinal stromal tumor was suspected. Subtotal gastrectomy with Billroth II anastomosis was performed. Histologically, pseudocystic degeneration of the heterotopic pancreas was confirmed. The patient showed eventful postoperative course except temporary dilated gastric emptying. The patient is doing well without any abnormal symptom at 8-month follow-up. This report is a rare case of gastric outlet obstruction caused by a pseudocyst originating from a heterotopic pancreas in the gastric antrum.
Abdominal Pain ; Female ; Follow-Up Studies ; Gastrectomy ; Gastric Emptying ; Gastric Outlet Obstruction ; Gastroenterostomy ; Gastrointestinal Stromal Tumors ; Humans ; Mucous Membrane ; Nausea ; Pancreas ; Pyloric Antrum ; Stomach ; Vomiting ; Young Adult

Colorectal polyps of mesenchymal origin are a rare group of colorectal disorders. A "mucosal Schwann-cell hamartoma," which is one type of polypoid lesion that originates from the mesenchyme, is a newly-proposed disease entity to be distinguished from the neurofibromas found in type-1 neurofibromatosis. This lesion is composed of pure Schwann-cell proliferation in the lamina propria and shows diffuse immunoreactivity for the S-100 protein. We report a case of a polypoid lesion of the colon with the features of this recently-proposed disease entity.
Colon ; Hamartoma ; Mesoderm ; Mucous Membrane ; Neurofibroma ; Neurofibromatoses ; Neuroma ; Polyps ; S100 Proteins ; Schwann Cells ; SNARE Proteins

No abstract available.
Echinococcosis, Hepatic*

PURPOSE: Cathepsin D, a lysosomal protease has been proposed to play a role in the local invasion and metastatic dissemination in primary breast cancer. Although there are many conflicting results, the overexpression of cathepsin D has been considered to be related with a poorer prognosis of breast cancer. This study was designed to verify whether cathepsin D expression is related to other prognostic factors in breast cancer. METHODS: Cathepsin D was assessed by immunohistochemistry using murine monoclonal anti-cathepsin D antibody (ZyMED) in 79 paraffin-embedded primary breast cancer specimens. Cathepsin D expression was compared to other prognostic parameters such as tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors (ER & PR), p53, c-erb B2, Ki-67, MVD (microvessel density), and Pgp (P-glycoprotein). RESULTS: A high-expression of cathepsin D was found in 35 of 79 patients (44.3%) with primary breast cancer. Cathepsin D expression was not related to tumor size, axillary lymph node metastasis, tumor histologic grades, hormone receptors, p53, Ki-67, or CD31. However, a significant relationship was found between cathepsin D expression and c-erb B2 (p=0.007), and between cathepsin D expression and Pgp (p=0.003). CONCLUSION: These results suggest that cathepsin D expression may be an indicator of a poor prognosis in breast cancer. However, further studies are required to verify the exact role of cathepsin D in the prognosis of breast cancer.
Breast Neoplasms* ; Breast* ; Cathepsin D* ; Cathepsins* ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis

Left ventricular(LV) diastolic filling is abnormal at rest in many patients with coronary arery disease, even in the presence of normal resting LV systolic function. To determine the effects of improved myocardial perfusion on impaired LV diastolic filling and to detect the most sensitive parameter to assess LV diastolic function, gated radionuclide ventriculography were performed in 14 patients with coronary artery disease before and after successful percutaneous transluminal coronary angioplasty(PTCA). All patients had no previous myocardial infarction and no abnormal wall motion in gated radionuclide and contrast ventriculography. The following results were obtained; 1) There were no significant differences in the parameters of LV systolic function, such as peak ejection rate(PER, time to peak ejection rate(TPER), ejection fraction(EF) after successful PTCA. 2) Peak filling rate(PFR) and time to peak filling rate(TPFR), indexes of LV diastolic function, had no significant changes after successful PTCA. 3) The percent contribution of late diastolic filling to stroke volume(%LDF/SV) decreased from 26.5+/-6.8% to 19.1+/-6.6%(p<0.005 by paired t-test). These data suggest that in many patients with angina and normal LV systolic function, impaired global diastolic filling is a reversible manifestation of impaired coronary flow, and percent contribution of late diastolic filling to stroke volume(%LDF/SV) can be a sensitive parameter to evaluate impaired LV diastolic filling in coronary artery disease.
Angina Pectoris* ; Angioplasty, Balloon, Coronary* ; Coronary Artery Disease ; Gated Blood-Pool Imaging ; Humans ; Myocardial Infarction ; Perfusion ; Radionuclide Ventriculography ; Stroke