Bilateral breast cancer is not a common clinical problem, and its occurance is not suprising in this paired organ. Bilateral breast cancer is categorized as synchronous or metachronous. We propose to evaluate clinical and biological characteristics in bilateral breast cancer. Previous cancer in one breast is the strongest known risk factor for cancer to develop in the second breast, and a young age at dignosis of a breast cancer and lobular type of tumor are additional risk factors related to bilaterality. Seventeen cases of bilateral breast cancer have been admitted to the department of General surgery, Samsung Cheil general Hospital from 1980 till 1995. We report the analysis of these cases with the references. The incidence of bilateral breast cancer among all case of total breast cancer was 2.1%(17/827). Synchronous breast cancer was 3 cases(0.4%) and metachronous breast cancer was 14cases (1.7%). The median age was 41 years. The mean age at diagnosis of the primary tumor in the metachronous group was 40 years. Among metachronous cases, the mean interval between the treatment of the primary cancer and the detection of secondary cancer was 37months. The clinical stage was 0-I in 12%, II in 50%, III in 32%, and IV in 6% of tumors. The majority of patients (88%) were clinically node positive. Out of a total of 34 tumors, the clinical tumor size Tis-T1 in 8 tumors, T2 in 21 tumors, and T3 in 5 tumors. Histopathologic type of the pimary tumor was the same with the second in 70%(12/17). The location of secondary breast cancer was in the upper outer quadrant in 9 cases, and in the upper medial quadrant of breast in 2 cases. The premenopausal primary cancer was in 50% of the patients, and postmenopausal primary cancer was in 50% of patients for whom this information was available. Median survival period was 57 months, and 5 year survival rate was 80%. Bilateral breast cancers have similar biological features to unilateral breast cancer more freqently than would be predicted by chance alone. The similarity in clinical aspects of unilateral and bilateral breast cancers should be considered in clinical management of patients with breast cancer. Further investigation is required to know these similaritics and differences between unilateral and bilateral breast cancer.
Breast Neoplasms* ; Breast* ; Diagnosis ; Hospitals, General ; Humans ; Incidence ; Population Characteristics ; Risk Factors ; Survival Rate

PURPOSE: An outbreak of influenza virus is uncommon in neonatal intensive care unit (NICU). The clinical presentation of influenza virus infection in neonates is diverse. This study was aimed to report an outbreak of influenza A in a NICU and to investigate the clinical characteristics of influenza virus infection in neonates especially preterm infants during the 2011-2012 influenza season in Korea. METHODS: We reviewed the medical records of 29 patients who were evaluated by respiratory virus multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) at NICU of Kosin University Gospel Hospital during the 2011-2012 seasonal influenza outbreak in Korea. RESULTS: Eleven patients (37.9%) were influenza A virus RT-PCR positive during the survey periods. They were all preterm infants and three of them had no symptoms. Eight patients had symptoms and it was fever (18%, 2/11), respiratory difficulty (72.7%, 8/11) without symptoms of upper respiratory infection, and gastrointestinal symptoms (27.3%, 3/11). The median duration of symptom was 5 days. There were differences of duration of admission at the test of respiratory RT-PCR, Clinical Risk Index for Babies (CRIB) score, use of mechanical ventilation, and use of dexamethasone before infection between influenza A virus RT-PCR positive and negative group. All 11 patients with influenza A were discharged without any complications. CONCLUSIONS: The symptoms of influenza A virus infection in the preterm infants is nonspecific. Influenza A virus should be considered as a possible cause of infection in NICU during the influenza season in the community.
Dexamethasone ; Fever ; Humans ; Infant, Newborn ; Infant, Premature ; Influenza A virus ; Influenza, Human* ; Intensive Care Units ; Intensive Care, Neonatal* ; Korea* ; Medical Records ; Orthomyxoviridae ; Respiration, Artificial ; Seasons*

OBJECTIVES: This study was conducted to investigate the job stress factors, psychosocial stress and their associations in workers engaged in the research and development of vehicles, and according to job role. METHODS: We recruited 4,066 subjects from workers at a research and development center of an automobile company. A total of 2,764 workers answered the questionnaire about socio-demographic factors, health behaviors, work-related factors, subjective labor intensity, KOSS, and SF-PWI. The final analysis included 2,282 male manufacturing and research workers. Univariate analyses and multiple logistic analyses were conducted on the complete questionnaire data to compare the job stress factors, psychosocial stress and their associations between research and manufacturing workers. RESULTS: The adjusted Odds ratios comparing the high risk group to the low risk group regarding PWI group were 2.23(95%CI=1.63-3.04) in "Lack of rewards", 1.64(95%CI=1.20-2.24) in "Interpersonal conflict", 1.59(95%CI=1.15- 2.20) in "Organizational injustice", 1.58(95%CI=1.17-2.14) in "Occupational climate" and 1.43(95%CI=1.05-1.94) in "Job insecurity" among research workers, and 2.46(95%CI=1.59 -3.80) in "Lack of rewards" and 1.94(95%CI=1.17-3.22) in "Organizational injustice" among manufacturing workers. CONCLUSIONS: There are differences in job stress factors between research and manufacturing workers. Further studies and discussions based on quantitative methodology for seeking more fundamental causes of these differences are required to establish job stress intervention plans and policies.
Automobiles ; Health Behavior ; Humans ; Male ; Odds Ratio ; Questionnaires

OBJECTIVE: The objective of this study was to elucidate the relationship between job stress and pulse wave velocity (PWV) as a cardiovascular risk factor. METHOD: The study design was cross-sectional, and a total of 234 industrial workers were recruited. A structured-questionnaire was used to assess the general characteristics and job characteristics (work demand, decision latitude) using a modified Karasek model. Cuffs were applied to the extremities and a microphone for phonocardiography was placed at the second intercostal space at the margin of the sternum. The subjects rested in a supine position for 5 min, and PWV was measured using a VP-1000(Colin Waveform analyzer). RESULTS: There were significant correlations between blood pressure, glucose, total cholesterol, coagulation factor and PWV. The group with low decision latitude and high decision latitude showed higher levels of PWV, but the differences were not significan. The PWV (left) was significantly higher in the high strain group than in the lower strain group. After adjustment for age and cardiovascular risk factors, job strain was still associated with PWV. CONCLUSION: These result suggest that the high strain group among workers is related to an increased risk of PWV as a marker of atherosclerosis.
Atherosclerosis ; Blood Coagulation Factors ; Blood Pressure ; Cholesterol ; Extremities ; Glucose ; Phonocardiography ; Pulse Wave Analysis* ; Risk Factors* ; Sternum ; Supine Position

In 1964, Abbott and Colleagues published the world's first heterotopic heart transplantation technique in the rat. Their method established circulation by end-to-end anastomoses of the graft's aorta and pulmonary artery to the recipient's abdominal aorta and Inferior Vena Cava (IVC), respectively. In 1966, Tomita et al altered Abbott's technique by employing end-to-side rather than end-to-end anastomoses, thus eliminating the hind leg paralysis that sometimes resulted from Abbott's technique. In order to prevent postsuture hemorrhage (since 7-0 silk suture was the finest available at that time), Tomita's aortic anastomosis was done with double up-and-down continuous suture technique. A single layer continuous anstomosis effected the pulmonary artery-IVC anastomosis. The availability of Nylon monofilament suture made it possible for Ono and Lindsey to use a single layer suture technique for the aortic end-to-side anastomosis in their modified rat heart transplantation. We observed survival time between control group and Immunosuppression (Cyclosporine administration, 10mg/Kgx4 times postoperatively) group after heterotopic heart transplantation in the rat model. The cyclosporine adminstration group survived longer than the control group, thus we concluded that cyclosporine was based on Immunosuppressive drugs.
Allografts ; Animals ; Aorta ; Aorta, Abdominal ; Cyclosporine ; Heart Transplantation* ; Heart* ; Hemorrhage ; Immunosuppression ; Leg ; Models, Animal* ; Nylons ; Paralysis ; Pulmonary Artery ; Rats* ; Silk ; Suture Techniques ; Sutures ; Vena Cava, Inferior

BACKGROUND: This study was performed to identify the incidence and prognostic significance of chromosomal abnormalities as well as clinical significance of immuno phenotype in patients with acute myelogenous leukemia (AML). METHODS: The chromosomal abnormalities, immunophenotype and their hematologic/clinical correlations were studied in 68 patients with de novo AML admitted to Pusan National University Hospital between January 1996 and December 2000. 47 of 68 patients had received induction chemotherapy and we analysed the response of treatment according to the karyotype pattern and immunophenotype. RESULTS: The karyotypic patterns were divided into three groups; favorable (t (8;21), t (15;17) and inv (16); n=19, 28%), poor (-5, del (5q), -7, der (1;7), abn (3q) and complex karyotypes; n=11, 16%) and intermediate group (other abnormalities or normal karyotype; n=38, 56%). The incidence of chromosomal abnormalities was 56% (38/68) and overall complete remission (CR) rate of 47 evaluable patients was 64%. The CR rates of favorable, intermediate and poor groups were 88%, 59% and 44%, respectively (p=0.021). The median survival time of all patients was 7 months, those of poor and intermediate groups being 2 months and 6 months. The median survival time of favorable group was not reached (p=0.008). The overall 5 year survival rate was 38% and those of favorable, intermediate and poor groups were 68%, 31% and 9%, respectively (p=0.009). Expression of CD7, CD14, CD33, CD34 and terminal deoxynucleotidyl transferase had no impact on CR rate and overall survival. In multivariate analysis, both age and chromosomal abnormalities influence significantly on prognosis. CONCLUSION: Cytogenetic study is important in predicting the outcome of patients with AML. And the treatment must be tailored according to the result of cytogenetics such as this study.
Adult* ; Busan ; Chromosome Aberrations* ; Cytogenetics ; DNA Nucleotidylexotransferase ; Humans ; Immunophenotyping ; Incidence ; Induction Chemotherapy ; Karyotype ; Leukemia ; Leukemia, Myeloid, Acute* ; Multivariate Analysis ; Phenotype ; Prognosis ; Survival Rate

BACKGROUND: We investigated the effects of the combined administration of nefopam, a N-methyl-D-aspartate receptor antagonist and low dose remifentanil, on early postoperative pain and analgesic requirement. METHODS: Fifty patients scheduled to undergo mastoidectomy and tympanoplasty were randomized to be given either nefopam 40 mg mixed with normal saline 100 ml (Group N) or an equal amount of normal saline (Group C) before anesthesia induction. Anesthesia was maintained with 5-6 vol% desflurane and remifentanil 0.05-0.15 microg/kg/min during the surgery. Postoperative pain was controlled by titration of ketorolac in the postanesthesia care unit (PACU) and ward. We evaluated the intraoperative remifentanil dose, recovery profiles, ketorolac demand in the PACU and ward, numeric rating scale (NRS) for pain at time intervals of every 10 min for 1 h in the PACU, 6, 12, 18 and 24 h in a ward, as well as the time to first analgesic requirement in the PACU and ward. RESULTS: Ketorolac demand and NRS in the PACU were significantly lower in Group N than Group C (P = 0.002, P = 0.005, respectively). The time to first analgesic requirement in the PACU in Group N were significantly longer than Group C (P = 0.046). There were no significant differences in intraoperative remifentanil dose, ketorolac demand, NRS, and the time to first analgesic requirement in the ward between the groups. CONCLUSIONS: Nefopam administration combined with low dose remifentanil infusion reduces pain and analgesic consumption during the immediate postoperative period in patients undergoing middle ear surgery under desflurane anesthesia.
Anesthesia* ; Ear, Middle* ; Humans ; Ketorolac ; N-Methylaspartate ; Nefopam* ; Pain, Postoperative ; Postoperative Period ; Tympanoplasty

BACKGROUND: Electromyography and acceleromyography are common neuromuscular monitoring devices. However, questions still remain regarding the use of acceleromyography in children. This study compared the calibration success rates and intubation conditions in children after obtaining the maximal blockade depending on each of the devices METHODS: Children, 3 to 6 years old, were randomly allocated to the TOF-Watch SX acceleromyography group or the NMT electromyography group. The induction was performed with propofol, fentanyl, and rocuronium. The bispectral index and 1 Hz single twitch were monitored during observation. The calibration of the each device was begun when the BIS dropped to 60. After successful calibration, rocuronium 0.6 mg/kg was injected. A tracheal intubation was performed when the twitch height suppressed to 0. The rocuronium onset time (time from administration to the maximal depression of twitch height) and intubating conditions were rated in a blinded manner. RESULTS: There was no difference in the calibration success rates between the two groups; and the calibration time in the electromyography group (16.7 +/- 11.0 seconds) was shorter than the acceleromyography group (28.1 +/- 13.4 seconds, P = 0.012). The rocuronium onset time of the electromyography group (73.6 +/- 18.9 seconds) was longer than the acceleromyography group (63.9 +/- 18.8 seconds, P = 0.042) and the intubation condition of the electromyography group (2.27 +/- 0.65) was better than the acceleromyography group (1.86 +/- 0.50, P = 0.007). CONCLUSIONS: Electromyography offers a better compromise than acceleromyography with respect to the duration of calibration process and surrogate for the optimal time of tracheal intubation in children.
Anesthesia, General* ; Calibration ; Child* ; Child, Preschool ; Depression ; Electromyography* ; Fentanyl ; Humans ; Intubation ; Neuromuscular Monitoring ; Propofol ; Prospective Studies*

OBJECTIVE: This study was conducted to compare the job characteristics (work demand, decision latitude, and job insecurity) and psychosocial stress levels of typical workers in the parent firm, to those of atypical workers in subcontracted firms. In addition the risk factors for psychosocial stress of atypical workers are evaluated. METHOD: The study design was cross-sectional, and 1,713 shipbuilding workers (681; typical workers, 1,032; atypical workers) were recruited. A structured-questionnaire was used to assess the general characteristics, job characteristics and psychosocial stress levels. We used the chi-square test for univariate and multiple regression analyses. RESULTS: In univariate analyses, there were significant differences in smoking, hobby, insufficient sleeping, work hours per week, quitting, unemployment, job demand, job decision latitude and job insecurity. The job strain was significantly higher in the atypical workers than in the typical workers. The proportion of iso-strain groups was significantly greater in the atypical workers than typical workers. Using psychosocial stress as the dependent variable, multiple regression models were estimated. After adjustment for sociodemographic factors, unemployment, quitting, employment type, job demand, job decision latitude and job insecurity were all found to be significantly associated with psychosocial stress. CONCLUSION: This result suggests that the psychosocial stress of atypical workers is related to job characteristics such as job insecurity and labor flexibility.
Employment ; Hobbies ; Humans ; Parents ; Pliability ; Risk Factors ; Smoke ; Smoking ; Unemployment

PURPOSE: Kikuchi-Fujimoto disease (KFD) is a benign disease, which is characterized by a cervical lymphadenopathy with fever, and it often mimics malignant lymphoma (ML). 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a powerful imaging modality for the diagnosis, staging and monitoring of ML, with the limitations including the nonspecific FDG uptake in infectious or inflammatory processes. This study compared clinical manifestations and PET/CT findings between KFD and ML patients. METHODS: We retrospectively reviewed the medical records of 23 patients with KFD and 33 patients with ML, diagnosed histopathologically, between January 2000 and May 2013 at the Department of Pediatrics, Yeungnam University Medical Center. Among them, we analyzed the clinical manifestations, laboratory findings and characteristics, and the amount of 18F-FDG uptake between 8 KFD and 9 ML patients who had 18F-FDG PET/CT. RESULTS: The 18F-FDG PET/CT maximum standardized uptake values (SUVmax) ranged from 8.3 to 22.5 (mean, 12.0) in KFDs, and from 5.8 to 34.3 (mean, 15.9) in MLs. There were no significant differences in SUVmax between KFDs and MLs. 18F-FDG PET/CT with ML patients showed hot uptakes in the extranodal organs, such as bone marrow, small bowel, thymus, kidney, orbit and pleura. However, none of the KFD cases showed extranodal uptake (P<0.001). 18F-FDG PET/CT findings of KFD with nodal involvement only were indistinguishable from those of ML. CONCLUSION: Patients who had extranodal involvement on PET/CT were more likely to have malignancy than KFD.
Academic Medical Centers ; Bone Marrow ; Child* ; Diagnosis ; Electrons ; Fever ; Fluorodeoxyglucose F18 ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Kidney ; Lymphatic Diseases ; Lymphoma* ; Medical Records ; Orbit ; Pediatrics ; Pleura ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography* ; Retrospective Studies ; Thymus Gland