OBJECTIVE: Fibromyalgia (FM) is a rheumatic disorder characterized by widespread bodily pain, tenderness at multiple sites, and fatigue. It has a major impact on the quality of life. However, there has been no report regarding the health-related quality of life (HRQOL) in Korean patients with FM. The objective of this study was to assess the HRQOL and the correlation among each measurement and to identify the predictors for HRQOL in Korean patients with FM. METHODS: The HRQOL and clinical parameters were assessed by Short Form Health Survey-36 (SF-36), EuroQol 5 Dimensions (EQ-5D), time trade off (TTO), standard gamble (SG), Centers for Epidemiologic StudiesDepression (CES-D), social support, self-efficacy scale, Fibromyalgia Impact Questionnaire (FIQ), and tender points, respectively, from 104 outpatients with FM. RESULTS: Of the 104 subjects, 99 (95.2 %) were women with mean (+/-SD) age of 49.2 years (+/-11.1). The mean (+/-SD) years of disease onset was 8.06 (+/-7.38). The mean (+/-SD) scores of SF-36 global, mental component summary (MCS) and physical component summary (PCS) were 41.6 (+/-19.8), 47.4 (+/-25.0), and 43.5 (+/-23.7), respectively. The SF-36 GH, PCS, MCS scores of FM patients were lower than that of healthy controls (p<0.001). The mean (+/-SD) EQ-5D utility and visual analog scale (VAS) were 0.52 (+/-0.32) and 55.6 (+/-19.4). The mean (+/-SD) scores of the TTO and SG were 0.49 (+/-0.44) and 0.47 (+/-0.42). The mean (+/-SD) scores of CES-D, self-efficacy scale, social support and social network were 16.0 (+/-10.2), 55.9 (+/-19.4), 2.37 (+/-0.27), and 2.07 (+/-0.58), respectively. The mean (+/-SD) scores of FIQ was 46.4 (+/-17.7). The FIQ total score was negatively correlated with the scores of SF-36 GH, MCS, PCS, EQ-5D utility and VAS, TTO, SG, social support, social network, and self-efficacy scale (r=-0.63, r=-0.60, r=-0.48, r=-0.59, r=-0.56, r=-0.32, r=-0.27, r=-0.25, r=-0.31, r=-0.54, respectively. all p's<0.001), and positively correlated with the CES-D (r=0.67, p<0.001). In multivariate models, the predicting variables of SF-36 GH and PCS were age, FIQ, and self-efficacy and the predicting variables of SF-36 MCS were income, FIQ, and social support. CONCLUSION: These results suggest that the HRQOL in Korean patients with FM is lower than healthy subjects. In a simple correlation analysis, FIQ, CES-D, social support, and self-efficacy were meaningful variables correlated with HRQOL. In multivariate model, age, FIQ, and self-efficacy were independent variables correlated with HRQOL. Therefore, the efforts to improve HRQOL in Korean patients with FM should be designed to improve the self-efficacy and depression in addition to conventional approach.
Depression ; Fatigue ; Female ; Fibromyalgia* ; Humans ; Outpatients ; Quality of Life* ; Surveys and Questionnaires ; Visual Analog Scale

BACKGROUND: A few studies have revealed increased levels of certain cytokines in patients with ischemic stroke. Cytokine changes have not been studied in patients with transient ischemic attack(TIA). The purpose of this study was to evaluate the temporal profile of the inflammatory response in patients with vertebrobasilar insufficiency (VBI) and to compare the inflammatory response between TIA and infarction through analyzing serum interleukin(IL)-6 and IL-10. METHODS: We serially measured the serum levels of IL-6 and IL-10 in 14 patients with VBI, 12 patients with vertebrobasilar territoy infarction, and 21 patients with lacunar infarction at the timing of admission, at 1 day after symptom onset, and at 5 day after symptom onset. Cytokines were measured by sandwich ELISA method. RESULTS: The IL-6 level obtained at day 1 was significantly elevated compared with the normal control group in patients with TIA (p<0.05). The IL-6 level at day 1 was the highest in patients with VBI. The level of IL-10 in patients with VBI was significantly higher than normal group at all time points(p<0.05). The IL-10 level at the timing of admission was the highest in patients with VBI. But the serum levels of IL-6 and IL-10 between VBI and vertebrobasilar territory and lacunar infarction groups did not show any differences. CONCLUSION: These findings show that pro- and anti-inflammatory cytokines in serum are elevated in patients with TIA. These results suggest that cytokine cascade occurs in TIA.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infarction ; Interleukin-10* ; Interleukin-6* ; Stroke ; Stroke, Lacunar ; Vertebrobasilar Insufficiency*

BACKGROUND: A few studies have revealed increased levels of certain cytokines in patients with ischemic stroke. Cytokine changes have not been studied in patients with transient ischemic attack(TIA). The purpose of this study was to evaluate the temporal profile of the inflammatory response in patients with vertebrobasilar insufficiency (VBI) and to compare the inflammatory response between TIA and infarction through analyzing serum interleukin(IL)-6 and IL-10. METHODS: We serially measured the serum levels of IL-6 and IL-10 in 14 patients with VBI, 12 patients with vertebrobasilar territoy infarction, and 21 patients with lacunar infarction at the timing of admission, at 1 day after symptom onset, and at 5 day after symptom onset. Cytokines were measured by sandwich ELISA method. RESULTS: The IL-6 level obtained at day 1 was significantly elevated compared with the normal control group in patients with TIA (p<0.05). The IL-6 level at day 1 was the highest in patients with VBI. The level of IL-10 in patients with VBI was significantly higher than normal group at all time points(p<0.05). The IL-10 level at the timing of admission was the highest in patients with VBI. But the serum levels of IL-6 and IL-10 between VBI and vertebrobasilar territory and lacunar infarction groups did not show any differences. CONCLUSION: These findings show that pro- and anti-inflammatory cytokines in serum are elevated in patients with TIA. These results suggest that cytokine cascade occurs in TIA.
Cytokines ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infarction ; Interleukin-10* ; Interleukin-6* ; Stroke ; Stroke, Lacunar ; Vertebrobasilar Insufficiency*

Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has been disseminating nationwide due to clonal spread and is taking a serious action at the national level in Korea. The mobilized colistin resistance (MCR1) gene confers plasmid-mediated resistance to colistin and is known to be capable of horizontal transfer between different strains of a bacterial species. We have experienced a fatal case of the patient who developed MCR1-possessing, ST307/Tn4401a[blaKPC2] K. pneumonia bacteremia in the community of non-capital region after being diagnosed as pancreatic cancer with multiple liver metastases and treated in the capital region. The ST307/Tn4401a[blaKPC2] K. pneumonia was the most commonly disseminated clone in Korea. Our strain is the first MCR1 and KPC2 co-producing K. pneumonia in Korea and our case is the critical example that the multi-drug resistant clone can cause inter-regional spread and the community-onset fatal infections. Fortunately, our patient was admitted to the intensive care unit on the day of visit, and the contact precaution was well maintained throughout and KPC-KP was not spread to other patients. The high risk patients for KPC-KP need to be screened actively, detected rapidly and preemptively isolated to prevent outbreak of KPC-KP. Inter-facility communications are essential and the nationwide epidemiologic data of KPC-KP should be analyzed and reported regularly to prevent spread of KPC-KP. The prompt identification of species and antimicrobial susceptibilities for successful treatment against KPC-KP should be emphasized as well.

PURPOSE: We analyzed the survival and failure patterns of cervix cancer patients treated with irradiation alone to evaluate our treatment method and to compare with the others. METHODS AND MATERIALS: Two hundred and twenty cervical cancer patients, Stage IB, IIA, and IIB who completed the planned treatment between May 1987 and December 1991 were analyzed retrospectively. The Stage IB patients were restaged to the Stage IB1 and IB2 by the recently revised FIGO classification. Patients were treated with a combination of external irradiation and the intracavitary brachytherapy. Determination of the tumor control was done at the time of 6 months postirradiation. The follow-up time was ranged from 3 to 115 months and the mean was 62 months and the follow-up rate was 93.6%(206/220). RESULTS: The overall 5-year survival rate of Stage IB1(N=50), IB2(N=15), IIA(N=58), and IIB(N=97) was 94%, 87%, 69%, and 56%, respectively. In the univariate analysis of prognostic factors,stage(0.00), initial Hg level (p=0.00), initial TA-4(tumor-associated) antigen level(p=0.02), initial CEA level(p=0.02), barrel-shaped tumor(p=0.02), whole cervical involvement (0.00), pelvic lymphadenopathy(LAP) in CT(p=0.04), and post-irradiation adjuvant chemotherapy(p=0.00) were statistically significant in survival analysis. In a while, multivariate analysis showed that the stage was the most powerful prognostic indicator and the post-irradiation chemotherapy factor also showed the statistical significance. The overall local control rate was 81% and by the stage, 100% in Stage IB1, 86.7% in Stage IB2, 84.5% in Stage IIA, and 68.1% in Stage IIB, respectively. The overall tumor recurrence rate was 15.5%(27/174) and by the stage, 8%(4/50) in Stage IB1, 0%(0/13) in Stage IB2, 22.4%(11/49) in Stage IIA, and 19.4%(12/62) in Stage IIB, respectively. CONCLUSIONS: We obtained the similar treatment results to the other's ones in early stage cervical cancer patients. But in Stage IIB, the local control rate was lower than that of the other institutes and also the survival was poorer. So it seems to be necessary to reevaluate the treatment method in advanced cervical cancer patients.
Academies and Institutes ; Brachytherapy ; Cervix Uteri* ; Classification ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms

Among nondepolarizing neuromuscular blocking agents, d-tubocurarine may cause blood pressure reduction due to ganglionic blockade and histamine release, while pancuronium and gallamine are associated with vagal blockade and heart rate acceleration. Metocurine, as a trimethylated derivative of d-tubocurarine synthesized by King in 1935, is known to have relatively long duration of action and produces little change in cardiovascular system. Despite its relative lack of cardiovascular effects, the accumulation of data with regard to human neuromus- cular pharmacology and the clinical use has been scant. One hundred and nine adult patients of either sex were anesthetized with thiopental sodium and 50% nitrous oxide with 1.5-2.5% enflurane. For evaluation of neuromuscular blocking effect of metocurine, train-of-four stimulation (2.0 Hz for 2 seconds) was applied at the wrist along the ulnar nerve distribution and the response was measured via ABM Datex. Systolic, diastolic blood pressure and heart rate were recorded continuously after administration of metocurine, d-tubocurarine or pancuronium. All data were analized by ANOVA, Scheffe test. The results are follows : 1) The mean onset times of metocurine 0.1, 0.2, 0.3 mg/kg groups were 119.5+/-40.0, 120.9+/-61.1, 84.8+/-61,1 seconds and the mean durations were 75.1+/-37.6, 104.9+/-42.1, 131.0+/-42.5 minutes respectively. 2) Single-bolus dose of metocurine 0.1, 0.2, and 0.3 mg/kg did not cause significant cardiovascular changes from the control values, but d-tubocurarine 0.3 mg/kg decreased mean systolic blood pressure significantly from 116.6+/-15.7 to 99.0+/-10.9 mmHg 2 minutes after injection. 3) Systolic blood pressures of metocurine 0.2 mg/kg (107.2+/-11.7 mmHg) and d-tubocurarine 0.3 mg/ kg (100.4+/-12.9 mmHg) were significantly different from that of pancuronivm 0.06 mg/kg (127.8+/-16. 0 mmHg) after 1 minute, and 2 minutes after injection, systolic blood pressure of metocurine 0.2 mg/ kg (110.2+/-14.3 mmHg) and d-tubocurarine 0.3 mg/kg (99.0+/-10.9 mmHg) were different from that of pancuronium 0.06 mg/kg (125.3+13.1 mmHg). Five minutes after injection, systolic pressure of d- tubocurarine 0.3mg/kg group (101.110.2mmHg) was significantly different from that of pancur-onium 0.06 mg/kg group (118.7+/-11.0 mmHg). 4) Diastolic blood pressure of d-tubocurarine 0.3 mg/kg (63.4+/-12.9 mmHg) was significantly differ- ent from that of pancuronium 0.06mg/kg (84.2+/-13.3mmHg) after 1 minute, and 2 minutes after injection, diastolic blood pressure or d-tubocurarine 0.3 mg/kg (65.4+/-11.3 mmHg) was different from that of pancuronium 0.06mg/kg (83.1+/-11.6mmHg). There was no significant difference among the groups with respect to heart rate. In summary, metocurine has relatively rapid onset and long duration of action, and used in a dose sufficient to provide surgical relaxation, it produces little change in cardiovascular system in contrast to d-tubocurarine or pancuronium. 1t is therefore suggested that metocurine may be recommended as a muscle relaxant for patients having cardiovascular disease.
Acceleration ; Adult ; Blood Pressure ; Cardiovascular Diseases ; Cardiovascular System ; Enflurane ; Gallamine Triethiodide ; Ganglion Cysts ; Heart Rate ; Hemodynamics* ; Histamine Release ; Humans ; Neuromuscular Blockade* ; Neuromuscular Blocking Agents ; Nitrous Oxide ; Pancuronium ; Pharmacology ; Relaxation ; Thiopental ; Tubocurarine ; Ulnar Nerve ; Wrist

No abstract available.
Cervix Uteri* ; Female ; Uterine Cervical Neoplasms*

Background/Aims: Recent advances in understanding the genetics of pancreatic ductal adenocarcinoma (PDAC) have led to the potential for a personalized approach. Several studies have described the feasibility of generating genetic profiles of PDAC with next-generation sequencing (NGS) of samples obtained through endoscopic ultrasound-guided tissue acquisition (EUS-TA). The aim of this study was to find the best EUS-TA approach for successful NGS of PDAC. Methods: We attempted to perform NGS with tissues from 190 patients with histologically proven PDAC by endoscopic ultrasound-guided fine-needle aspiration and endoscopic ultrasound-guided fine-needle biopsy at Samsung Medical Center between November 2011 and February 2015. The medical records of these patients were retrospectively reviewed for parameters including tumor factors (size, location, and T stage), EUS-TA factors (needle gauge [G], needle type, and number of needle passes) and histologic factors (cellularity and blood contamination). The sample used for NGS was part of the EUS-TA specimen that underwent cytological and histological analysis. Results: NGS could be successfully performed in 109 patients (57.4%). In the univariate analysis, a large needle G (p=0.003) and tumor located in the body/tail (p=0.005) were associated with successful NGS. The multivariate logistic regression analysis revealed that the needle G was an independent factor of successful NGS (odds ratio, 2.19; 95% confidence interval, 1.08 to 4.47; p=0.031). Conclusions The needle G is an independent factor associated with successful NGS. This finding may suggest that the quantity of cells obtained from EUS-TA specimens is important for successful NGS.

BACKGROUND/AIMS: Controversy remains over the optimal approach to preoperative biliary drainage in patients with resectable perihilar cholangiocarcinoma. We compared the clinical outcomes of endoscopic biliary drainage (EBD) with those of percutaneous transhepatic biliary drainage (PTBD) in patients undergoing preoperative biliary drainage for perihilar cholangiocarcinoma. METHODS: A total of 106 consecutive patients who underwent biliary drainage before surgical treatment were divided into two groups: the PTBD group (n=62) and the EBD group (n=44). RESULTS: Successful drainage on the first attempt was achieved in 36 of 62 patients (58.1%) with PTBD, and in 25 of 44 patients (56.8%) with EBD. There were no significant differences in predrainage patient demographics and decompression periods between the two groups. Procedure-related complications, especially cholangitis and pancreatitis, were significantly more frequent in the EBD group than the PTBD group (PTBD vs EBD: 22.6% vs 54.5%, p<0.001). Two patients (3.8%) in the PTBD group experienced catheter tract implantation metastasis after curative resection during the follow-up period. CONCLUSIONS: EBD was associated with a higher risk of procedure-related complications than PTBD. These complications were managed properly without severe morbidity; however, in the PTBD group, there were two cases of cancer dissemination along the catheter tract.
Aged ; Aged, 80 and over ; Bile Duct Neoplasms/*surgery ; Bile Ducts/surgery ; Cholangitis/etiology ; Drainage/adverse effects/*methods ; Endoscopy, Gastrointestinal/adverse effects/*methods ; Female ; Humans ; Klatskin Tumor/*surgery ; Liver/surgery ; Male ; Middle Aged ; Pancreatitis/etiology ; Postoperative Complications/etiology ; Preoperative Care/adverse effects/*methods ; Treatment Outcome

We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.
Female ; Fluoroscopy ; Follow-Up Studies ; Humans ; Middle Aged ; Phrenic Nerve ; Recurrence ; Respiratory Function Tests ; Thymoma