This study was conducted to assess the risk of breast cancer by menstrual, reproductive, and lactational factors in Korean women. A total of 210 women living in Seoul aged 30 to 60 with a first diagnosis of breast cancer from 2 teaching hospitals in Seoul, and 249 control subjects, randomly selected from the female pensioners of Korean Medical Insurance Company living in Seoul were interviewed. There was a increasing risk with the decrease of age at menarche, and the adjusted odds ratio(OR) of early menarche(age 14 years or less compared with over 17 years) was 1.61(95% Confidence Interval [CI]: 0.95-2.74). The longer the interval between menarche and regular menstruation, the less risk of breast cancer(OR=0.31, 95% CI: 0.16-0.60). The effect of these menarche factors were more prominent among premenopausal women. The adjusted OR for the second category(25-29 years old) of the age at first pregnancy and the age at the first full term pregnancy, compared to the reference category( 24 years old), were 0.52(95% CI: 0.30-0.92) and 0.58(95% CI: 0.32-1.06), respectively. The late age at the last full term pregnancy had significant protective effect (OR=0.29, 95% CI: 0.10-0.88), and the age itself was important rather than the interval between the first and last full term pregnancy. Factors related to breast feeding(BF) had protective effect consistently. Among parous women, in referent to no BF, women with 1 year of BF had adjusted OR of 0.34(95% CI: 0.17-0.68), while those with 1-3 years of BF had 0.35(95% CI: 0.18-0.67), 3-5 years had 0.29(95% CI: 0.12-0.74), and more than 5 years had 0.06(95% CI: 0.02-0.17). Age at menarche with regular cycle have stronger effect on especially pre-menopausal breast cancer among Korean women. Recent increase in breast cancer incidence in Korea would be explained by delayed age at first pregnancy or delivery, earlier age at menarche and last delivery, and decrease in brest feeding.
Breast Feeding ; Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Diagnosis ; Female ; Hospitals, Teaching ; Humans ; Incidence ; Insurance ; Korea* ; Menarche ; Menstruation ; Pensions ; Pregnancy ; Seoul

Presented in this paper are the experimental results that measure rapid prototyping (RP) errors in 3D medical models. We identified various factors that can cause dimensional errors when producing RP models, specifically in maxillofacial areas. For the experiment, we used a human dry skull. A number of linear measurements based on landmarks were first obtained on the skull. This was followed by CT scanning, 3D model reconstruction, and RP model fabrication. The landmarks were measured again on both the reconstructed models and the physical RP models, and these were compared with those on dry skull. We focused on major sources of errors, such as CT scanning, conversion from CT data to STL models, and RP model fabrication. The results show that the overall error from skull to RP is 0.64+/-0.36mm(0.71+/-0.66%) in absolute value. This indicates that the RP technology can be acceptable in the real clinical applications. A clinical case that has applied RP models successfully for treatment planning and surgical rehearsal is presented. Although the use of RP models is rare in the medical area yet, we believe RP is promising in that it has a great potential in developing new tools which can aid diagnosis, treatment planning, surgical rehearsal, education, and so on.
Diagnosis ; Education ; Humans ; Skull ; Tomography, X-Ray Computed

PURPOSE: Although surgical resection offers patients with HCC the chance of a cure, the post-resection tumor recurrence rate is high, with reported cumulative 5-year tumor recurrence rates ranging from 40 to 70%. The objective of this study was to investigate risk factors for intrahepatic recurrence after resection of hepatocellular carcinoma, especially in patients with hepatitis B virus infection. METHODS: Between January 1999 and December 2003, 59 patients in our Hospital with hepatitis B virus infection underwent liver resection for hepatocellular carcinoma. Clinical, biological, and histopathological characteristics of these patients were collected and tested for their prognostic significance using a Chi-square test and a Student's t-test. Time to recurrence and survival rate were analyzed by the Kaplan-Meier method. RESULTS: Of the 59 patients who underwent liver resection, 24 (41%) experienced intrahepatic recurrence. The 1-, 3-, and 5-year overall survival rates of total enrolled patients were 83%, 63%, and 42%, respectively. The 1-, 3-, and 5-year overall survival rates after recurrence were 87%, 52%, and 20%, respectively. The risk factors for early recurrence were elevated serum aspartate aminotransferase (AST) level (p=0.044) and larger tumor size (p=0.049). For late recurrence, greater tumor size (p=0.039) was the only risk factor. CONCLUSION: Tumor size and serum aspartate aminotransferase are risk factors of intrahepatic recurrence after resection of HCC in patients with chronic hepatitis B virus infection. This finding indicates that patients who have these risk factors should be under more careful supervision and have more aggressive follow-up.
Aspartate Aminotransferases ; Carcinoma, Hepatocellular ; Follow-Up Studies ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Liver ; Organization and Administration ; Recurrence ; Risk Factors ; Survival Rate ; Viruses

Rifampin, when given in usual doses, is well tolerated with less than 4% of patients having significant adverse reactions. The patient had did not have any adverse reaction to rifampin in the first place. After 10 years, however, the patient was presented with hypotension, shortness of breath, wheezing and deterioration of consciousness in 10 minutes after taking rifampin. All abnormal symptoms and signs of anaphylaxis were normalized in 24 hours after administration of normal saline, glucocorticosteroid, and antihistamine. Skin prick test with rifampin showed positive reaction to gradual concentration of rifampin in dose dependent manner. The wheals by rifampin developed in 30 minutes and maximized in 2 hours, while normal saline and histamine controls showed expected negative and positive response in 10 minutes, respectively. Recently we expererienced a rare case of anaphylaxis after single oral administration of rifampin (450mg), who had been treated with antituberculous drug including rifampin, ca 10 years ago.
Administration, Oral ; Anaphylaxis* ; Consciousness ; Dyspnea ; Histamine ; Humans ; Hypotension ; Respiratory Sounds ; Rifampin* ; Skin

Coxiella burnetii is the etiological agent of Q fever, that may occur either acutely or the chronically. To understand the seroepidemiological patterns of C. burnetii infection in Korea, we examined a total of 3,178 sera from patients with acute febrile episodes by using indirect immunofluorescence assay (IFA) for detectable antibodies to C. burnetii and other eight rickettsial antigens. The IFA seropositivity>or=1:20 for C. burnetii phase II was 11.5% (368 out of 3,178 sera). The co-existence of antibodies to other rickettsial antigens was found in 216 out of the 368 positive sera. Thirty-seven point five percent (n=138) had antibodies to R. tsutsugamushi (cutoff>or=1:20), 16% (n=59) to Ehrlichia sennetsu, 14.9% (n=55) to Rickettsia typhi, 13.5% (n=50) to R. akari, 11.4% (n=42) to R. japonica, 8.9% (n=33) to R. prowazekii, 7.6% (n=28) to R. sibirica, and 6.7% (n=25) to R. conorii by IFA, respectively. These results are consistent with previous reports documenting diverse serum cross-reactivity in chronic Q fever. Therefore we excluded the samples that reacted to other rickettsial antigens at same or higher titers than to C. burnetii, resulting in the seropositive rate of 4.1%. The serological prevalence was 2% (n=64) when the conventional cut-off titer of 1:80 was used. Our results suggest that infections with C. burnetii are more prevalent than expected previously and should be differentially diagnosised for febrile illness occurring after exposure to ticks or other vectors.
Antibodies ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Korea ; Neorickettsia sennetsu ; Prevalence ; Q Fever ; Rickettsia ; Rickettsia typhi ; Seroepidemiologic Studies* ; Ticks

Infective endocarditis is a dreaded complication in dialysis or kidney transplantation patients, with high morbidity and mortality. Despite the improved early survival of the transplanted kidney with new immunosuppressive agents, the number of patients returning to dialysis after a failed renal allograft is increasing. There is no consensus on the optimal management of immunosuppression in patients with a failed allograft. Continued immunosuppression is associated with infection, and the rapid discontinuation of immunosuppression may lead to acute rejection. Therefore, it is important to taper the immunosuppression properly in patients with a failed renal allograft. We report on a hemodialysis patient with a failed renal allograft who had a cerebral infarction following infective endocarditis. The patient was treated successfully with antibiotics and valve replacement.
Anti-Bacterial Agents ; Cerebral Infarction ; Consensus ; Dialysis ; Endocarditis ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Renal Dialysis ; Transplantation, Homologous ; Transplants

A 43-year-old male presented with effort angina. Ammonia positron emission tomography (PET) revealed reversible perfusion defect in left anterior descending artery (LAD) and left circumflex artery (LCX) territories with decreased coronary flow reserve. Coronary angiogram showed significant stenosis in proximal LAD and intermediate diffuse stenosis in LCX and right coronary artery (RCA). Fractional flow reserve (FFR) showed similar results with ammonia PET. After percutaneous coronary intervention for LAD and LCX, flow and pressure checked by PET and FFR showed improvement. Simultaneously use of ammonia PET and FFR could be useful for determining ischemia-inducible lesion especially in diffuse intermediate lesion with discrepancy between functional studies.
Adult ; Ammonia ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Humans ; Male ; Percutaneous Coronary Intervention* ; Perfusion ; Positron-Emission Tomography*

BACKGROUND: Headache is one of the most common symptoms having experienced by many people. High school girls are expected to experience headache very often. Their proper treatment and adequate medical service is doubtful, and stressful environment of the Korean high school will augment the chronicity of headache. Knowing the forms of headache and categorizing the headache according to headache classification system is important for proper treatment of headache. Types of headache in high school girls have been categorized using International Headache Society (IHS) system. The relationships of headache with Beck Depression Inventory (BDI) and Family APGAR score of the headache groups and control group are investigated. Thus, the purpose of this study was to attribute to the treatment of the headache in female youths. METHODS: The questionnaires .on headache, under direct interviews, was given to each high school girls in Seoul, from March 1 to 31, 1999. The headache group was subclassified into migraine group, tension headache group and other headache group, using IHS system. Furthermore, the migraine group was subclassified into migraine with aura (classic migraine), migraine without aura (common migraine) and other migronous disorder. The students who had not experienced any headaches during the recent one year have been selected as the normal group. The normal group was compared with the headache group, i.e., tension headache and migraine. Depressed tendency was assessed using the BDI; and family function was evaluated by Family APGAR. The data are analyzed using SPSS 8.0. RESULTS: Among the subjects, 304 (60.4%) high school girls had experienced a headache during the previous one year. The girls with migraine, tension headache, and other types of headache were 110 (38%), 81 (27%) and 113 (35%), respectively. The migraine group showed higher BDI scores (p<0.01). Also, the migraine group showed more depressiveness than the normal group (p<0.01), according to the scores on the BDI which were greater than the cutting score of 21. In the Family APGAR, there was no significant difference between the headache groups and the normal group.(P>0.05) CONCLUSIONS: When the headache in high school girls was classified by using IHS system, headache in the migraine group was more prevalent than in the tension headache group and normal group. And the migraine group had more depressive tendency. When physicians deal with the headache in high school girls, they need to be aware of migraine headache and associated depressive tendency.
Adolescent ; Apgar Score ; Classification ; Depression ; Female* ; Headache* ; Humans ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Seoul ; Tension-Type Headache ; Surveys and Questionnaires

PURPOSE: To determine the features revealed by two-phase spiral CT scanning useful for differential diagnosis between recurrent cancer and benign wall thickening in patients who have undergone subtotal gastrectomy for stomach cancer. MATERIALS AND METHODS: We retrospectively reviewed 25 cases in which wall thickening of more than 1 cm in the remnant stomach after subtotal gastrectomy was revealed by two-phase spiral CT scanning. All cases were confirmed: 11 were recurrent cancer, and in 14, benign wall thickening was demonstrated. We analyzed the CT findings including maximal thickness of the gastric wall, patterns of wall thickening, degree of contrast enhancement seen during the arterial and portal phases, and the presence of perigastric strands. Maximal wall thickness was classified as either more or less than 15 mm, and as either focal or diffuse. We also determined whether lymphadenopathy was present. RESULTS: Mean maximal gastric wall thickness was 18.4 mm in the recurrent cancer group ("group A") and 12.6 mm in the benign group ("group B") . The gastric wall was thicker than 15 mm in 10 of 11 group A cases and in 3 of 14 in group B; wall thickening was focal (n=3) or diffuse (n=8) in group A, and focal (n=13) or diffuse (n=1) in group B, while the enhancement patterns seen during the arterial and portal phase, respectively, were high/high (n=8), low/high (n=1) and low/low (n=2) in group A, and low/low (n=7), low/high (n=4), high/low (n=1) and high/high (n=2) in group B. Perigastric strands were observed in nine cases in group A, but in none in group B, while lymphadenopathy was combined with wall thickening in seven group A cases but in none of those in group B. CONCLUSION: In patients who have undergone subtotal gastrectomy for gastric cancer, two-phase spiral CT findings including maximal thickness of the gastric wall, patterns of wall thickening, degree of contrast enhancement seen during the arterial and portal phase, the presence of perigastric strands, and lymphadenopathy are useful for differential diagnosis between recurrent cancer and benign wall thickening.
Diagnosis, Differential ; Gastrectomy* ; Gastric Stump ; Humans ; Lymphatic Diseases ; Retrospective Studies ; Stomach Neoplasms* ; Tomography, Spiral Computed*

beta -Blockers can cause bronchospasm in asthma. beta 2-agonists prolong the QT interval and alter the clinical course of long QT syndrome (LQTS). We report a case of asthma exacerbation treated cautiously with beta 2-agonists in a patient with LQTS, while LQTS was controlled with low-dose beta 1-antagonists. A 31-year-old woman with LQTS visited the emergency room for asthma exacerbation. FEV1 was 0.5 L (18%) and QTc interval was 520 ms. Low doses of salbutamol or salmeterol were used and gradually increased, while monitoring the QT interval. Simultaneously, a low dose of atenolol was maintained. FEV1 was increased to 2.2 L (83%) without further QT prolongation or cardiac events. The case suggests that lower doses of beta 1-antagonists can be tried for cardiac diseases, even in the presence of asthma exacerbations. beta 2-Agonists may be initiated at lower doses and, if tolerated, the dose can be increased in asthmatic patients with a risk for QT prolongation.
Adrenergic beta-Agonists ; Adrenergic beta-Antagonists ; Adult ; Albuterol ; Asthma ; Atenolol ; Bronchial Spasm ; Emergencies ; Female ; Heart Diseases ; Humans ; Long QT Syndrome ; Salmeterol Xinafoate