To evaluate the correlation between the histologic grade and DNA ploidy or proliferation index/S phase fraction (SPF) of gastrointestinal stromal tumors, we performed the DNA analysis using the flow cytometry. Paraffin embedded tissue samples of 57 gastrointestinal stromal tumors were used. The sites of the tumors were: stomach (28), small intestine (23), and large intestine(6). DNA index, proliferative index, and SPF by the flow cytomery were compared with histologic grade. The histologic grade of the gastric tumors were benign (12), borderline (10), and malignant (6). Those of the small intestinal timors were benign (2), borderline (13), and malignant(8). The large intestine were borderline (2), and malignant (4). In stomach, aneuploidy was found in 25.0% of benign, 40.0% of borderline, and 100% of malignant. And there was statistically significant correlation between the histologic grade and ploidy (p < 0.05). By contrast, small and large intestinal tumors showed more frequent aneuploidy in benign than in malignant. The proliferative index was correlated with the histologic grade in gastric tumors (p<0.05), but the SPF was not. In conclusion, the ploidy and proliferative index of gastric tumors are closely correlated to the histologic grade. However, aneuploidy in tumors of the small and large intestine were difficult to predict the malignancy.
Aneuploidy ; DNA* ; Flow Cytometry ; Gastrointestinal Stromal Tumors ; Indonesia ; Intestine, Large ; Intestine, Small ; Paraffin ; Ploidies ; Stomach

OBJECTIVES: This study was conducted to determine the appropriate sampling time of the salivary stress markers, chromogranin A (CgA) and cortisol as objective indices of job stress assessment in adult females. METHODS: The subjects were 20~39-year-old women (13 office workers, 11 sales-service workers, and 11 college students) who were eligible for the study and free of acute and chronic medical conditions. Salivary CgA and cortisol levels were determined by enzyme-linked immunosorbent assay (ELISA). Saliva samples were collected (2ml each) at 7:00, 8:00, 10:30, 12:00, 17:30, and 22:30 on a typical day. Salivary CgA and cortisol levels, according to sampling time, were compared among the three groups using general linear model. The full version of the Korean Occupational Stress Scale (KOSS), which includes socioeconomic characteristics, health behavior, work-related characteristics, and BMI, was used to access the subjects' job stress. Multiple regression analysis of the job stressors identified by the KOSS was performed on salivary CgA and cortisol levels. RESULTS: The salivary CgA level peaked at 7:00 (time of awakening), then decreased and were maintained at a low level throughout the day, and increased slightly at 17:30. The salivary cortisol level increased steeply within the 1st hour after awakening, followed by a gradual decrease by 12:00, and was then maintained at a low level throughout the day. The salivary cortisol levels of subjects who worked < or =5 days per week and graduated from the university were significantly lower at 8:00 (p=0.006). The salivary cortisol levels of non-smokers were significantly lower at 7:00 (p=0.040) and 8:00 (p=0.003) compared to smokers. There were no significant differences in salivary CgA and cortisol levels at 10:30 and 12:00 in general characteristics. The regression coefficients on salivary CgA level were significant with interpersonal conflict at 17:30 and job insecurity at 22:30. Regression coefficients on salivary cortisol level were significant with organizational system and total job stressors at 17:30. CONCLUSIONS: We suggest that the appropriate sampling times for the salivary stress markers, CgA and cortisol, are at 7:00 (time of awakening), 8:00 (1 hour after awakening), 17:30 (early evening), and 22:30 (before sleep).
Adult ; Biological Markers/metabolism ; Chromogranin A/*metabolism ; Circadian Rhythm ; Female ; Humans ; Hydrocortisone/*metabolism ; Korea ; Saliva/*metabolism ; Stress, Psychological/diagnosis/etiology/*metabolism ; Workplace/*psychology ; Young Adult

BACKGROUND AND OBJECTIVE: In assessing the health-related quality of life of subjects with allergy, it is important to measure outcomes which are relevant to the concerns of patients. The goals of this study were to compare health-related quality of life and stress level among allergy, healthy and other-diseases groups, and also to compare the relationship of health-related quality of life and stress. METHOD: The study group consisted of 129 subjects with allergy, 139 healthy subjects and 68 subjects with other-diseases. The allergy group was divided into two sub groups: pure allergy group(65) and allergy group with other diseases(64). They completed a questionnaire measuring perceived health-related quality of life, stress and demographic characteristics. The health-related quality of life score was measured by Notingham Health Profile and the stress level was measured by Ok-Suk Lee's instrument. RESULTS: (1) In allergy group with other diseases, the total scores of health-related quality of life were significantly higher than for healthy, pure allergy and other-diseases groups. The results indicated that the perceived health-related quality of life of allergy group with other diseases was in the lowest status among the four groups. (2) Forty-two percent of allergy group with other diseases were in need of treatment for stress level. (3) Level of stress and scores of health-related quality of life have shared linear correlation in healthy and allergy group; higher stress indicates lower status in the quality of life for both groups. CONCLUSION: This study was examined the QOL and the stress level of allergy subjects. When compared with healthy and other-diseases groups, the scores of QOL and the level of stress of the pure allergy group were higher than those of the healthy group, and those of the allergy group with other diseases were also significantly higher than those of the other-diseases group. These results suggest a necessity for futher assessment to improve the QOL and to reduce the stress in allergy subjects.
Humans ; Hypersensitivity* ; Quality of Life* ; Surveys and Questionnaires

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility. For induced hypotension, many methods have been used. Recently esmolol is favored in induced hypotension because of its short action and easy controlability, but thoracic epidural block is seldom used in induced hypotension. So we compared the effect of esmolol and thoracic epidural block in induced hypotension. METHOD: Patients scheduled for spinal posterior fusion under general anesthesia were randomly divided into two groups. In thoracic epidural group (Group I, 20 patients), 8~10 ml of 2% lidocaine was injected into the epidural catheter located in T6-7 interspace in a bolus. In esmolol group (Group II, 20 patients), 0.5 mg/kg of esmolol received as loading dose and 50~150 microgram/kg/min infused continuously. We measured mean arterial pressure, central venous pressure, heart rate, amounts of administrated fluids, urine output and VAS score. RESULT: There were no statistically significant differences between the two groups in amounts of bleeding, administered fluid, urine output. The elapsed time to reach the state of induced hypotension (MAP 55~65 mmHg) is 15.1 2.4 min after lidocaine injection in Group I and 6.1 2.7 min after esmolol injection in Group II (p<0.05). There were statistically significant differences between two groups in mean arterial pressure in 10 min after the injection (p<0.05). But there was apparent difference in VAS score in postoperative 1 hrs, 2 hrs and 6 hrs (p<0.05). CONCLUSION: Thoracic epidural block is another method for induced hypotension. And postoperative pain control can be easily achieved by injection through epidural catheter.
Anesthesia, General ; Arterial Pressure ; Catheters ; Central Venous Pressure ; Heart Rate ; Hemorrhage ; Humans ; Hypotension* ; Lidocaine ; Pain, Postoperative

BACKGROUND: Prediction of therapeutic response to radioactive iodine (RAI) in Graves disease is poorly understood. Although thyrotropin binding inhibitor immunoglobulin (TBII) level is a strong index for relapse after antithyroid drug treatment, conflicting results are described regarding its prognostic significance in Graves disease treated with RAI. This study is to evaluate possible prognostic factors including TBII wbich affect the outcome of RAI therapy in Graves disease. METHODS: Two hundred and one patients with Graves disease who were followed for over 12 months after RAI treatment were studied retrospectively. The subjects were divided into hypothyroid, euthyroid and hyperthyroid groups, based on the thyroid function evaluated at 12 months after RAI therapy. We evaluated the association of clinical parameters including patients age, goiter size, degree of hyperthyroidism and TBII index with outcome of RAI treatment. RESULTS: In Graves disease, response rate to RAI was 70.1% (hypothyroid 22.4% and euthyroid 47.7%) until 12th month. The mean age of hypothyroid group was 40+/-11 years, significantly older than that other groups (euthyroid: 33+/-12, hyperthyroid: 35+/-13, p<0.05). Initial level of thyroid function, duration of antithyroid drug treatment prior to RAI, goiter size and dosage of RAI were not significantly different between the groups. There were 61 patients who had both TBII tests before and after RAI. Twelve had negative TBII and 49 had positive TBII before RAI admini-stration. The rate of unremitted hyperthyroidism after RAI therapy was significantly lower in patients with negative TBII than in those with positive TBII prior to RAI treatment( 0% versus 46.9%, p<0.05). CONCLUSION: Graves patients with positive TBII prior to RAI therapy were associated with lower therapeutic response to RAI than those with negatve TBII. And old age was associated with the development of early hypothyroidism after RAI therapy. These results suggest these factors be also considered in the treatment of Graves disease with RAI.
Goiter ; Graves Disease* ; Humans ; Hyperthyroidism ; Hypothyroidism ; Immunoglobulins ; Iodine* ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyrotropin

BACKGROUND: In Korea before the enforcement of the medical reform in July 2000, it was generally difficult to analyze the conditions of prescriptions in hospitals and clinics. It was true that the circulation process of prescribed medicine was unclear and that there was no support between medical and pharmaceutical industries with the government. Also with the reality of high rate of pharmaceutical expenses among medical costs in Korea, it was necessary to enforce reform of medical and pharmaceutical industries and for our citizens to follow the new reform as well in order to prevent drug abuse and reduce medical costs. This research was to provide basis for future studies on prescription conditions and related factors through compared analysis of before and after the medical reform by analyzing university hospital prescriptions. METHODS: A comparison and analysis of patients, who visited a university hospital for medical treatment, was dpme. There were 23,974 patients in March 2000, and 22,550 patients in March 2001. During these periods 16,870, 12,919 prescriptions were each issued, respectively. RESULTS: There was a total of 46,524 outpatients with 29,789 prescription issued. There were 23,974 outpatients in March 2000 and 22,550 in March 2001 with 16,870 and 12,919 prescriptions, respectively. Among the outpatients, there were 20,769 men (44.6%) and 24,471 women (52.6%) with 13,527 and 16,209 prescriptions, respectively. In comparing the outpatients and prescription issued patients in March 2000 and in March 2001, both men and women showed decrease in the number of prescriptions (P <.001). Also in the ages between 0-15, 16-40 and 41-65, there was a clear evidence of decrease in the number of both outpatients and prescription issued patients (P<0.001). However in the age group of 65 and over there was an increase of 4,453 patients from 3,956 outpatients. The patient analysis in March 2000 and March 2001 excluding the outpatients in emergency, urology, dentistry and radiology shows a decrease in the number of patients in medical departments in general. Also except for the increase of prescription authorized patients in dentistry, urology and family health, it showed a decrease. In general, there was a decrease in the number of cases in the issuance of prescriptions excluding few item changes in the upper 1st to 10th medicine categories in prescribed frequencies. For prescribed medicine categories no vast difference existed. In total medicine categories, there was a decrease in injections from 24.5% to 12.3% and increase of oral medications from 64.5% to 73.8%. Also there was a significant decrease of prescriptions in injections for antibiotics and significant increase of prescription for anti-hypertensive agents such as Angiotensin Converting Enzyme inhibitors. CONCLUSION: This study involved before and after the reform of prescription conditions and obtained related factor information. The results may differ depending on the type of a hospital, patient distribution and local area, but has provided valuable basic research information which did not exist in previous university hospital unit. Hence in relation to the before and after the medical reform, future studies on diseases and on significant changes in elderly patient care, antibiotic usage and in categories of anti-hypertensive agents may be necessary.
Aged ; Angiotensin-Converting Enzyme Inhibitors ; Anti-Bacterial Agents ; Antihypertensive Agents ; Dentistry ; Drug Industry ; Emergencies ; Family Health ; Female ; Hospital Units ; Humans ; Korea ; Male ; Outpatients* ; Patient Care ; Prescriptions* ; Substance-Related Disorders ; Urology

OBJECTIVES: In most DEHP exposure assessment studies, single spot urine sample was used. It could not compare the exposure level among studies. Therefore, we are going to represent the necessity of selection of proper sampling time of spot urine for assessing the environmental DEHP exposure, and the association urinary DEHP metabolites with steroid hormones. METHODS: We collected urine and plasma from 25 men. The urine sampling times were at the end of the shift (post-shift) and the next morning before the beginning of the shift (pre-shift). Three metabolites of DEHP {mono(2-ethylhexyl) phthalate [MEHP], mono-(2-ethyl-5-hydroxyhexyl)phthalate [MEHHP], and mono(2-ethyl-5-oxohexyl)phthalate [MEOHP]} in urine were analyzed by HPLC/MS/MS. Plasma luteinzing hormone, follicle stimulating hormone, testosterone, and 17beta-estradiol were measured at pre-shift using a ELISA kit. A log-transformed creatinine-adjusted urinary MEHP, MEHHP, and MEOHP concentration were compared between the post- and pre-shift. The Pearson's correlation was calculated to assess the relationships between log-transformed urinary MEHP concentrations in pre-shift urine and hormone levels. RESULTS: The three urinary metabolite concentrations at post-shift were significantly higher than the concentrations in the pre-shift (p<0.0001). The plasma hormones were not significantly correlated with log-transformed creatinine - adjusted DEHP metabolites. CONCLUSIONS: To assess the environmental DEHP exposure, it is necessary to select the urine sampling time according to the study object. There were no correlation between the concentration of urinary DEHP metabolites and serum hormone levels.
Adult ; Diethylhexyl Phthalate/analogs & derivatives/pharmacokinetics/*urine ; Estradiol/blood ; Follicle Stimulating Hormone/blood ; Humans ; *Laboratories, Dental ; Luteinizing Hormone/blood ; Male ; Middle Aged ; Occupational Exposure/*analysis ; Phthalic Acids/urine ; Specimen Handling/*methods ; Testosterone/blood ; Time Factors

BACKGROUND: Electroconvulsive therapy (ECT) still remains a place in modern psychiatric practice. The anesthetic agent for ECT should provide smooth and rapid induction, rapid recovery and attenuation of the physiologic effects of ECT as well as minimal antagonistic effects on seizure activity. We performed a study to assess the comparative effects of propofol and thiopental sodium on seizure activity, hemodynamic stability, and recovery after ECT. METHODS: Ten patients scheduled for maintenance ECT participated in this prospective, randomized, crossover study. The induction dose was 1.5 mg.kg 1 of propofol and 3 mg.kg 1 of thiopental sodium. The lengths of motor and EEG seizure were measured after each electric stimuli. Mean arterial pressure, heart rate and recovery time were also compared between two groups. RESULTS: Both propofol and thiopental sodium were associated with mean motor and EEG seizure durations above thirty seconds. However, the improved hemodynamic stability associated with propofol and recovery time of propofol (8.1 +/- 2.8 min) was shorter than thiopental sodium (13.0 +/- 9.3 min). CONCLUSIONS: Compared with thiopental sodium, the use of propofol was associated with a clinically insignificant decrease in seizure duration and improved hemodynamic stability, recovery time. We conclude that propofol may be a useful alternative to thiopental sodium for ECT therapy.
Anesthetics* ; Arterial Pressure ; Cross-Over Studies ; Electroconvulsive Therapy* ; Electroencephalography ; Heart Rate ; Hemodynamics* ; Humans ; Propofol* ; Prospective Studies ; Seizures* ; Thiopental*

An increasing interest in intravenous anesthetic techniques has resulted from the availability of more efficacious intravenous agents, possible discomfor of the patient on endotracheal intubation and the concern over anesthetic pollution in the operating room. This study was done to investigate the effect of intravenous anesthesia with ketamine on the respiratory system by comparing arterial blood gas analysis before and after the procedure. Analysis of arterial blood for PCO2, PO2, pH, and excess were carried out. Heart rate and blood pressure were monitored on 15 patients in ASA class l for diagnostic or short procedures. Each patient was premedicated with atropine 0.01mg/kg and valium 0.2mg/kg intramuscularly 30 minutes before the procedure. ketamine was administered intravenously 1.0~1.5 mg/kg or intramuscularly 3~5mg/kg for induction of anesthesia. The anesthesia was maintained with ketamine 0.5~1.0mg/kg and valium 0.1mg/kg ever 5 to 10 minutes. The results of this study showed that ketmine anesthesia seemed not to cause any untoward effect on respiratory function. In other words, ketamine seems to be a safe and good intravenous anesthetic agent for diagnostic or short surgical procedures.
Anesthesia ; Anesthesia, Intravenous* ; Atropine ; Blood Gas Analysis ; Blood Pressure ; Diazepam ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Intubation, Intratracheal ; Ketamine* ; Operating Rooms ; Respiratory System

Although failure of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) is generally believed to be associated with cross-resistance to other EGFR TKI, the benefit of administering erlotinib as a second EGFR TKI after resistance of gefitinib as the first TKI has been well known. However, good response to gefitinib after an initial response to erlotinib has been rare. We report that a 45-year-old woman (never smoked), with lung adenocarcinoma and EGFR mutation, showed an initial response to erlotinib, and then responded to gefitinib again.
Adenocarcinoma ; Female ; Humans ; Lung ; Lung Neoplasms ; Middle Aged ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride