No abstract available.
Cushing Syndrome*

PURPOSE: This study was to develop a valid and reliable self-care performance scale for stomach cancer patients with gastrectomies. METHODS: The initial items for the self-care performance scale were derived by a literature review and in-depth interviews with stomach cancer patients with gastrectomies and a conceptual framework based on Orem's theory was used. The identified items were evaluated for content validity by experts. The main survey with refined items was performed with a sample of 232 patients. The data were analyzed using item analysis, Pearson correlation coefficients, Cronbach's alpha and factor analysis. RESULTS: A 22 item instrument with 7 factors was developed and the total variance explained was 66.9%. The factors were 'manage dietary restriction', 'avoid hazards', 'rest and elimination', 'manage social support and stress', 'regulation diet', 'meal portion control' and 'seek information and follow-up care'. The internal consistency, Cronbach's alpha was .86 and reliability of the subscale ranged from .65 to .82. CONCLUSION: This study suggested that the self-care performance scale is a reliable and valid instrument to measure self-care performance for patients with stomach cancer after gastrectomy.
Follow-Up Studies ; Gastrectomy* ; Humans ; Self Care* ; Stomach Neoplasms* ; Stomach* ; Weights and Measures

PURPOSE: The purpose of this study is to analyze the smoking behaviors and to identify the impacts of depression, temperament, and characteristic on smoking experience in the female adolescents. METHODS: This study surveyed 691 highschool girls in the Gangwon area using self-administered questionnaires. Data were analyzed by SPSS 12.0. using Pearson correlation coefficient and multiple regression. RESULTS: The smoking rate of the highschool girls was lower than that of the national average. Depression was observed to be seriously in the highschool girls. There were a positive correlations among smoking experience, the school records and novelty seeking and a negative correlation between smoking and cooperativeness. The significant predictors of smoking experience were the type of school, the satisfaction with school, the school records, novelty seeking, reward dependence and cooperativeness. CONCLUSION: These results suggest that femalel adolescents who have the factors identified in this study are considered to have the potential for smoking. These results provide the basis for developing smoking prevention and cessation programs.
Adolescent* ; Depression* ; Female ; Gangwon-do ; Humans ; Reward ; Smoke* ; Smoking* ; Temperament* ; Surveys and Questionnaires

OBJECTIVE: The aim of study was to analyze obstetric and neonatal causes of Korean neonatal deaths. METHODS: The study subjects are a cohort of infants who were born during 1996 and who died before their first birthday. The data were collected through three stages of the study: the collection of existing data, a national infant mortality survey at medical facilities, and data integrating and adjusting process. The sources of existing data were health insurance data and the resident registration data. The National infant mortality survey was conducted by both 'Ministry of Health and Welfare' and 'Korea Institute for Health and Social Affairs'. 3930 medical and health facilities where obstetrics services are available were surveyed during November 1998. The survey results were computerized to match data sets, and any overlap among different data sets were filtered. Causes of deaths were grouped according to the KCD (Korean Standard Classification of Diseases). Causes of neonatal death were further analyzed using composite causes combining obstetric and neonatal conditions. RESULTS: Causes of 2,433 neonatal death were known out of 2,856 deaths. "Certain conditions originating in the perinatal period" comprised 77.1% of neonatal death, being the most common cause. The next common cause was 'congenital malformations, deformations and chromosomal abnormalities', constituting 15.7% of neonatal death. Among the 'certain conditions originating in the perinatal period', 'respiratory distress of newborn' constituted 17.1% of neonatal deaths and 'disorders related to short gestation and low birth weight', constituted 15.6% of neonatal deaths. Neonatal sepsis constituted 14.8% of neonatal death. Among congenital malformations 'congenital malformation of the heart' was most common, constituting 6.2% of neonatal death. 'Certain conditions originating in the perinatal period' was more important cause of preterm neonatal death. Of the related maternal condition, idiopathic preterm birth, multifetal pregnancy, premature rupture of the membranes and hypertensive diseases during pregnancy were common conditions. Congenital malformation was the most important cause of term neonatal death. CONCLUSION: Prematurity-related condition was more important cause of preterm neonatal death while congenital malformation was the most important cause of term neonatal death.
Cause of Death ; Classification ; Cohort Studies ; Dataset ; Gestational Age ; Health Facilities ; Humans ; Infant ; Infant Mortality ; Insurance, Health ; Membranes ; Obstetrics ; Parturition ; Pregnancy ; Premature Birth ; Rupture ; Sepsis

During the last decade, many clinical investigators at various cancer centers have reported the efficacy of various chemotherapeutic agents in the treatment of osteosarcoma. The regimens using high-dose methotrexate (HDMTX) with citrovorum factor rescue are now considered to be one of the most effective treatments of choice. From December 1989 to May 1991, sixteen patients with Enneking's stage (Enneking et al., 1980) IIB osteosarcoma of the extremities were treated with a high-dose methotrexate regimen. After two cycles of preoperative chemotherapy, an operation was performed; either limb salvage or amputation. The resected lesions were examined pathologically and classified according to Huvos' criteria. On pathological examination, 8 (50%) cases showed Grade IV; 1 (6.25%) Grade III; 4 (25%) Grade II; and 3 (18.75%) Grade I. The types of surgery performed were tumor prosthesis replacement (11); wide resection with or without reconstruction (2); resection and arthrodesis (1); and amputation (2).
Adolescent ; Adult ; Bone Neoplasms/*drug therapy/pathology/surgery ; Child ; Combined Modality Therapy ; Female ; Humans ; Male ; Methotrexate/administration & dosage/*therapeutic use ; Osteosarcoma/*drug therapy/pathology/surgery

Indolent T-lymphoblastic proliferation has been rarely reported in the upper aerodigestive tract. The lymphoid cells associated with this condition have the morphological and phenotypical features of immature thymocytes. However, their pathogenesis and biology are unknown. We present an unusual type of tumor infiltrating lymphocytes in a case with hepatocellular carcinoma, presumed to be a T-lymphoblastic proliferation. A 58-yr-old female patient presented with indigestion and a palpable epigastric mass. The abdominal computed tomography revealed a mass in the S6 region of the liver. A hepatic segmentectomy was performed. Microscopic examination showed dense isolated nests of monomorphic lymphoid cells within the tumor. Immunohistochemically, the lymphoid cells were positive for CD3, terminal deoxymucleotide transferase (TdT) and CD1a. In addition, they showed dual expression of CD4 and CD8. The polymerase chain reaction used to examine the T-cell antigen receptor gamma gene rearrangement showed polyclonal T-cell proliferation. This is the second case of hepatocellular carcinoma combined with indolent T-lymphoblastic proliferation identified by an unusual tumor infiltrating lymphocytes.
Antigens, CD3/metabolism ; Antigens, CD4/metabolism ; Antigens, CD8/metabolism ; Carcinoma, Hepatocellular/*diagnosis/pathology/secondary ; DNA Nucleotidylexotransferase/metabolism ; Female ; Humans ; Liver Neoplasms/*diagnosis/immunology/pathology ; Lymphocytes, Tumor-Infiltrating/*pathology ; Mastectomy, Segmental ; Middle Aged ; Precursor Cells, T-Lymphoid/*pathology ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/complications/metabolism/*pathology ; Tomography, X-Ray Computed

A human malignant lymphoid cell line(JeKo-1) was established from a Korean patient with retroperitoneal tumor presenting peripheral blood and bone marrow involvement by malignant lymphoid cells. This cell line was established from peripheral blood, and the cell line had the identical immunophenotypic features as malignant cells from the peripheral blood. The established cell line had features of a mature B-cell phenotype with no evidence for commitment to other lineages. The JeKo-1 grows in suspension with a doubling time of 33 hours. By light and electron microscopic examination, the established cells had a follicular center showing, a small, cleaved, lymphoid appearance, and had a large amount of cytoplasm containing few vacuoles and an irregular cytoplasmic membrane. Immunophenotypic analyses with monoclonal antibodies using flow cytometry showed a monoclonal IgM kappa and CD5- B-cell phenotype. The cells were non-reactive for T-cells and myeloid/monocyte antigens, and no evidence of Epstein-Barr virus nuclear antigen by polymerase chain reaction. DNA analysis showed a hypodiploid stemline with a DNA index of 0.83. The established cells were strongly reactive for bcl-2 and c-myc onco-protein, but lacked expression of multidrug resistance gene protein, p-glycoprotein by Western blot analysis. Karyotypic analysis of JeKo-1 showed 40-41 chromosomes. This cell line should be a valuable tool to study the dissemination of malignant lymphoma into the peripheral blood and bone marrow.
Humans

We experienced a case of adult T cell leukemia/lymphoma (ATLL) in a 48-year-old Korean female, who has never been abroad since birth and no history of blood transfusion. The patient had hypercalcemia and multiple lymphadenopathy. Histopathologic study of left cervical lymph node (LN) and bone marrow (BM) revealed that infiltrates of malignant lymphoid cells were composed of small, medium and large cells with pleomorphic nuclei. Smears of peripheral blood (PB) showed lymphopenia (16%) with the appearance of a few atypical lymphoid cells (less than 2%), but not the typical clover leaf cells seen in ATLL. Immunophenotypic study of LN and BM revealed T cell phenotype. PB showed increased CD4+ T cell (T(H), CD3/CD4+, 57%) and decreased CD8+ T cell counts (T(S), CD3/CD8+, 6.7%). The sera of the patient and her family were reactive for HTLV-I antibody. The specific sequences of pol, env, and tax of HTLV-I DNA were detected in the lymphoma cells and peripheral blood mononuclear cells (PBMC) using polymerase chain reaction. Ultrastructural examination of PBMC confirmed numerous type c virus particles in extracellular space. This case was an acute type of ATLL without overt leukemic features in PB. Despite chemotherapy and intensive conservative treatment, she died 3 months after admission.
Biopsy ; Bone Marrow/pathology ; Case Report ; DNA, Viral/analysis ; Fatal Outcome ; Female ; Flow Cytometry ; Gene Products, env/genetics ; Gene Products, pol/genetics ; Gene Products, tax/genetics ; HTLV-BLV Infections/pathology ; HTLV-I ; Human ; Hypercalcemia/virology ; Hypercalcemia/pathology ; Immunophenotyping ; Korea ; Leukemia, T-Cell/virology ; Leukemia, T-Cell/pathology* ; Leukemia, T-Cell/immunology ; Lymph Nodes/pathology ; Lymphopenia/virology ; Lymphopenia/pathology* ; Lymphopenia/immunology ; Microscopy, Electron ; Middle Age ; Support, Non-U.S. Gov't ; T-Lymphocytes/virology ; T-Lymphocytes/ultrastructure ; T-Lymphocytes/pathology

PURPOSE: To evaluate the role of enhanced MR imaging in monitoring tumor response to preoperativechemotherapy for osteosarcomas. MATERIALS AND METHODS: Fo r t y - s even patients (30 males and 17 females, witha mean age 17 years ; range 8 -44 years) with osteosarcomas were included in this study. We obtained spin echoT1-, T2-, and enhanced T1-weighted images before and after pre-operative chemotherapy and in all patientscorrelated changes in MR parameters with histopathologic response. We also obtained 19 specimen MR images,correlating these with histopathologic results in order to estimate tissue specific signals. Patients with morethan 10% viable tumor in the resected specimen were considered poor respon-ders(n=26), while those with 10% orless viable tumor were considered good respon-ders(n=21). RESULTS: Four distinct patterns of signal intensitycorresponded, respectively to dead bone and dense fibrosis (low on T1- and T2-weighted images), viable tumor cells(in-termediate on T1- and high on T2-weighted images), necrosis (low on T1- and high on T 2 - weighted images),and hemorrhage (high on T1- and T2-weighted images), but a wide range of overlap was noted. In all four groups,viable tumor cells remained. Increased tumor vo l u m e, stable or increased edema and enhancement were goodpre-dictors of poor response (predictive values of 83%, 77%, and 89%, respectively). Decreased enhancement was theonly reliable predictor of good response (predictive value, 73%). Changes in tumor margin, homogeneity, signalintensity, and joint effu-sion did not correlate with histopathologic response. CONCLUSION: Signal intensities donot reflect histologic nature. Enhanced MR imaging is a useful predictor of tumor response to preoperativechemotherapy.
Drug Therapy* ; Edema ; Female ; Fibrosis ; Hemorrhage ; Humans ; Joints ; Magnetic Resonance Imaging* ; Male ; Necrosis ; Osteosarcoma*

OBJECTIVE: To determine the dincal significance of placenta previa totalis. METHODS: Maternal and neonatal medical rerords were reviewed retrospectively. Between March 1990 and June 1997, sixty-nine pregnant women with placenta previa totalis delivered at Asan Medical Center. Diagnosis of placenta previa totalis was confirmed during cesarean section. RESULTS: Mean maternal age at diagnosis was 31.7+ 3.9 years and 3 patients(4.3%) were nullipara. Fifty two patients(75%) had the history of vaginal bleeding during their index pregnancy and seventeen of 52 patients were admitted more than once. Median gestational age at the time of initial bleeding episode was 33.2 weeks(range 23.5-41. 1) and median interval from the first admission to delivery was 11 days(range 1-63), Major placental implantation site was posterior uterine wall(64%, 44/69). Six cases(8%) were complicated with placenta accreta or increta and no case was combined with abruptio placentae. Estimated blood loss at the time of cesarean section was 1,510+/-952ml(mean+/-SD) and 43 patients(62%) were transfused. No case was complicated with disseminated intravascular coagulation. Eight patients(11.6%, 8/69) underwent cesarean hysterectomy because of uncontrollable bleeding. Thirty four patients(49.3%) delivered their babies before 37 weeks of gestation. The mean gestational age at delivery was 36.4+/-3.0 weeks(mean+/-SD). Major neonatal morbidity was respiratory distress syndrome(20.3%, 14/69). Perinatal death rate was 4.3%(3/70). CONCLUSION: Because pregnant women complicated with placenta previa totalis have high probability for transfusion and cesarean hysterectomy, these patients should be managed cautiously and thoroughly. The most frequent neonatal morbidity was respiratory distress syndrome due to preterm delivery.
Abruptio Placentae ; Cesarean Section ; Chungcheongnam-do ; Diagnosis ; Disseminated Intravascular Coagulation ; Female ; Gestational Age ; Hemorrhage ; Humans ; Hysterectomy ; Maternal Age ; Mortality ; Placenta Accreta ; Placenta Previa* ; Placenta* ; Pregnancy* ; Pregnant Women ; Retrospective Studies ; Uterine Hemorrhage