PURPOSE: To identify factors associated with care of diabetic retinopathy. METHODS: The fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) is a nationwide survey. This survey included 1, 257 people aged 40 years and older with a history of diabetic mellitus who answered questions, "Within one year, have you ever received eye examination (fundus photography) for screening diabetic retinopathy?" Factors that affect care of diabetic retinopathy were identified using multiple logistic regression analysis. RESULTS: Among the 1,257 people aged 40 years and older, 464 (36.9%) received screening for diabetic retinopathy. People aged 65 years and older (aOR = 0.7, 95% CI: 0.51-0.85) with university education (aOR = 0.5, 95% CI: 0.32-0.74) were more likely to undergo screening for diabetic retinopathy compared to those in the reference category (40-64 years old and those who had elementary school or lower education). People living in rural areas were less likely to undergo screening for diabetic retinopathy compared to those living in urban areas (aOR = 1.7, 95% CI: 1.32-2.24). Diabetic retinopathy screening was also associated with self-reported health status (ref: unhealthy [aOR = 1], fair [aOR = 1.7, 95% CI: 1.25-2.23], and healthy [aOR = 1.8, 95% CI: 1.30-2.44]). CONCLUSIONS: To increase nationwide screening rates for diabetic retinopathy, more attention should be given to underserved groups, particularly people aged between 40 and 64 years, those with a low education level, those living in rural areas, and those with a positive attitude toward self-reported health status. These issues highlight the need for a new emphasis in health education and public health policies aimed towards these underserved groups.
Aged ; Diabetic Retinopathy ; Eye ; Health Education ; Humans ; Korea ; Logistic Models ; Mass Screening ; Nutrition Surveys ; Public Health

OBJECTIVE: The purpose of this study was to review the incidence, types, chemotherapy regimens, operation methods, pregnancy rate and propiosis of the ov#arian malignancy under the age of twenty years old. METHODS: Retrospective reviews of the medical recordings for 22 patients with ovarian malignancy under the age of twenty years old in the Department of Obstetrics and Gynecology, Hanyang University from 1986 to 1997 were done. RESULTS: Gerin cell tumor accounts for the majority of cases (77%), whereas 5 patients(23%) belong to the common epithelial poup which were all mucinous type. Our experiences with 22 cases are as followings: 5 mucinous cystadenocarcinoma, 8 immature teratoma, 4 endodermal sinus tumor, 3 dysgernma and 2 mixed germ cell tumor. The incidence of this group was 8.2% (22/266) in all ovarian malignancy. Fourteen of them are stage I, each one is, stage II and IV, and six patients are stage III. The average age was 14.9 years old in germ cell tumor and 18.4 yems old in mucinous cystadenoearcinoma. Malignant ovarian cancer under the age of twenty can be treated with conservative surgery, followed by adjuvant chemotherapy. Commonly used chemotherapeutic regimens were VAC(Vincristine, Actinomycin-D; Cyclophosphamide), VBP(Vinblastine, Bleomycin, Cisplatin) and BEP(Bleomycin, Etoposide, Cisplatin). Second look operations were done in 11 patienth and histologic positive findings were detected in 4 of them. The length of follow-up ranged ftom 3 months to 137 months and median value was 44 rnonths. CONCLUSIONS: It is concluded that for young women who wish to preserve child-bearing capacity, regardless of the stage of the tumor, fertility preserving surgery with complete surgical staging, if necessary followed by combination chemotherapy is an appropriate treatment.
Bleomycin ; Chemotherapy, Adjuvant ; Cystadenocarcinoma, Mucinous ; Drug Therapy ; Drug Therapy, Combination ; Endodermal Sinus Tumor ; Etoposide ; Female ; Fertility ; Follow-Up Studies ; Gynecology ; Humans ; Incidence ; Medical Records ; Mucins ; Neoplasms, Germ Cell and Embryonal ; Obstetrics ; Ovarian Neoplasms ; Pregnancy Rate ; Retrospective Studies ; Teratoma

BACKGROUND/AIMS: Liver cirrhosis is an end-stage liver disease. Ito cell is known to have central role in fibrogenes is of liver cirrhosis. But collagen content and Ito cell activity in liver cirr hosis have received little attention. So Ito cell activity and hepatocyte proliferation activity according to collagen content was investigated. WAF-1 and c- met were studied to evaluate the effect of cell cycle. METHODS: We analyzed 56 cases of liver cirrhosis ( viral:41, biliary:11, alcoholic:2, Wilson' s disease:2). Collagen content was measured by spectrophot ometry. Ito cell activity and prolifer ation index was measured by-SMA and Ki- 67 immunohistochemistry. RESULTS: In viral cirrhosis, high collagen group showed increased Ito cell activity compared to low collagen group. There was no difference in hepatocyte prolifer ation activity bet ween high and low collagen group in viral cirrhosis. In biliary cirrhos is, high collagen group showed increased Ito cell activity in septal zones compared to low collagen group. WAF- 1and c- met were negative in most of cases. CONCLUSION: Collagen content of liver cirrhosis is closely related to increment of activated Ito cells . Ito cell activity was prominent in septal zones than in parenchymal areas of viral cirrhosis and that was only significant in septal zones of biliary cirrhosis. There is no correlation bet ween collagen content and hepatocyte proliferation activity.
Cell Cycle ; Collagen* ; Fibrosis ; Hepatic Stellate Cells ; Hepatocytes* ; Immunohistochemistry ; Liver Cirrhosis* ; Liver Cirrhosis, Biliary ; Liver Diseases ; Liver*

Endovascular treatment of the aortic aneurysm with a stent graft is rapidly evolving. We describe here a case of hybrid TEVAR (thoracic endovascular aortic repair) in which the stent grafts were placed in the aortic arch after debranching of the arch vessels. The patient had undergone ascending aorta replacement for acute type I aortic dissection 2.5 years earlier. The aneurysmal change of the distal dissection progressed with time. A provisional bypass surgery from the ascending aorta to the innominate artery and left carotid artery was performed and then stent grafts were inserted via an antegrade route that covered the whole aortic arch and proximal descending thoracic aorta.
Aneurysm ; Aneurysm, Dissecting ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Brachiocephalic Trunk ; Carotid Arteries ; Chimera ; Humans ; Stents ; Transplants

PURPOSE: To evaluate the effect of tamsulosin, solifenacin, and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents. MATERIALS AND METHODS: A total of 168 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (6 Fr, 24 or 26 cm), which were removed a mean of 14 days postoperatively. A total of 48 patients were given no medication (Group 1), 43 patients were given tamsulosin 0.2 mg once daily (Group 2), 45 patients were given solifenacin 5 mg once daily (Group 3), and 32 patients were given a combination of two agents postoperatively (Group 4). International Prostate Symptom Score/quality of life (IPSS/QoL) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1 day postoperatively and on the day of stent removal. RESULTS: In the total group of patients, the mean age was 50.24+/-12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4. Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the QoL score. There were no significant differences in the VAPS. CONCLUSIONS: Combination therapy with tamsulosin and solifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms.
Humans ; Lower Urinary Tract Symptoms ; Pain Measurement ; Polyurethanes ; Prostate ; Quinuclidines ; Stents ; Sulfonamides ; Tetrahydroisoquinolines ; Ureter ; Ureteroscopy ; Urinary Calculi ; Solifenacin Succinate

A 26-year-old man presented with lower abdominal discomfort and a palpable mass in the right lower quadrant. An abdominal computed tomography (CT) scan revealed an abdominal wall mass that extended from the dome of the bladder. Fluorine-18 fluorodeoxyglucose (FDG) positron-emission tomography/CT (PET/CT) showed hypermetabolic wall thickening around the bladder dome area that extended to the abdominal wall and hypermetabolic mesenteric infiltration. Differential diagnosis included a urachal tumor with invasion into adjacent organs and chronic inflammatory disease. Partial cystectomy with abdominal wall mass excision was performed, and the final pathologic report was consistent with urachal actinomycosis.
Abdominal Wall ; Actinomycosis ; Adult ; Cystectomy ; Diagnosis, Differential ; Humans ; Positron-Emission Tomography ; Urachal Cyst ; Urinary Bladder

Aortic pseudoaneurysms are rare. When aortic pseudoaneurysms are detected, they demand timely surgical intervention because they trend to increase in size and cause complications. We experienced a rare case of a chronic traumatic pseudoaneurysm located at the distal descending aorta associated with chest pain during trans-urethral resection of the prostate under spinal anesthesia. Diagnostic testing led to appropriate management.
Anesthesia, Spinal ; Aneurysm, False* ; Aorta, Thoracic ; Chest Pain* ; Diagnostic Tests, Routine ; Prostate* ; Thorax*

Primary cardiac sarcomas are extremely rare. We report a case of a primary cardiac sarcoma with myxoid change, which originally presented as a benign cardiac myxoma on a two- dimensional echocardiogram. On operating, the mass was found to extend into the posterior left atrial wall, the left pulmonary vein, and the mitral valve. The patient underwent wide resection of the left atrium, a mitral valve replacement and a left pneumonectomy. The histological diagnosis was of an undifferentiated primary cardiac sarcoma. The patient had postoperative chemotherapy. The patient expired 11 months after surgery due to a recurrence of the cardiac sarcoma. Although most tumors that develop in the left atrium are benign myxomas, we should make a preoperative differential diagnosis.
Adult ; Diagnosis, Differential ; Female ; Heart Atria ; Heart Neoplasms/*pathology/surgery/ultrasonography ; Human ; Intraoperative Period ; Myxoma/*pathology/ultrasonography ; Sarcoma/*pathology/surgery/ultrasonography

BACKGROUND: It has been reported that the recently developed intermittent antegrade warm blood cardioplegia (IAWBC) has better myocardial protective effects during coronary artery bypass surgery than cold blood cardioplegia or continuos retrograde cold blood cardioplegia. The aim of this study is to evaluate the safety and usefulness of IAWBC by comparing it retrospectively with intermittent retrograde cold blood cardioplegia (IRCBC). MATERIAL AND METHOD: From April 2001 to Feb. 2003, fifty seven patients who underwent isolated coronary surgery were divided into two groups (IAWBC vs. IRCBC). The two group had similar demographic and angiographic characteristics. There were no statistical differences in age, sex, Canadian Cardiovascular Society Functional Classification for angina, ejection fraction, and number of grafts. RESULT: Aortic cross clamping time and total pump time in IAWBC (99+/-23 and vs. 126+/-32 min) were shorter than those of IRCBC (118+/-32 min. and 185+/-48 min.)(p<0.05). The reperfusion time (13+/-7 min) in IAWBC was shorter than that of IRCBC (62+/-109 min.)(p<0.05). CKMB at 12 hours and 24 hours (16+/-15 and 9+/-13) in IAWBC was lower than that of IRCBC (33+/-47 and 17+/-26)(p<0.05). The awakening time in IAWBC (2+/-1 hour) was shorter than that of IRCBC (4+/-3)(p<0.05). The number of spontaneous heart beat recovery in IAWBC (85%) was more than that of IRCBC (35%)(p<0.05). The cardiac index after discontinuing cardio-pulmonary bypass was significantly elevated in the IAWBC group. The prevalence of perioperative myocardial infarction in IAWBC (4%) was lower than that of IRCBC group (20%)(p<0.05). CONCLUSION: Intermittent antegrade warm blood cardioplegia is a safe, reliable, and effective technique for myocardial protection. It can also provide simpler and economic way than the retrograde cold cardioplegia by shortening of cardio- pulmonary bypass time and avoiding retrograde cannulation for coronary sinus.
Catheterization ; Classification ; Constriction ; Coronary Artery Bypass ; Coronary Sinus ; Heart ; Heart Arrest, Induced* ; Humans ; Myocardial Infarction ; Prevalence ; Reperfusion ; Retrospective Studies ; Transplants

PURPOSE: Recent studies have reported the association between metabolic syndrome and benign prostatic hyperplasia. This study was conducted to evaluate the relation between metabolic syndrome and prostate-specific antigen (PSA). MATERIALS AND METHODS: From January 2004 to December 2007, a total of 4,115 male outpatients (aged 40 to 79 years) who visited the health care center at our medical center were examined. Eligible men were classified according to the presence or absence of metabolic syndrome and the number of components of the metabolic syndrome. The association between the sum of metabolic syndrome components and PSA level was evaluated. The association between each metabolic syndrome component and PSA level was also evaluated. RESULTS: The PSA level of metabolic syndrome patients was lower than that of the control group (p=0.022). An increased number of metabolic syndrome components was significantly associated with a linear, decreasing trend in PSA levels (p-trend=0.040). When a Pearson's correlation was performed, only obesity was inversely associated with PSA level in the metabolic syndrome group. There was no significant factor that was related to having a PSA level greater than or equal to 2.5 ng/ml. CONCLUSIONS: Metabolic syndrome should be considered as a factor associated with reduced PSA levels. If the patient with metabolic syndrome is obese, the PSA cutoff value should be lower than 4 ng/ml.
Delivery of Health Care ; Humans ; Male ; Metabolic Syndrome X ; Obesity ; Outpatients ; Prostate-Specific Antigen ; Prostatic Hyperplasia