BACKGROUND: In order to treat obese individuals, control of caloric intake after determination of patient's energy expenditure and recommendation of exercise program with possible use of specific medication is advised. There are many limitations in measuring all individuals energy expenditure by calorimetry, thus estimation is made using many variables such as weight, height, age, and gender. But, commonly used equations to predict resting energy expenditure(REE) are thought to result in overestimation of energy expenditure for use with obese individuals. This study investigated difference between measured and predicted resting energy expenditure in obese individuals. METHODS: Subjects were 133 adults who were admitted either to Internal Medicine Department and ENT Department of Yeung Nam University Hospital and their resting energy expenditure was measured by indirect calorimetry. According to age, sex, smoking habits and body mass index, Measured REE by indirect calorimetry between groups was compared. Predicted REE estimated by 6 equations to measured REE was compared in the two groups by body mass index 27kg/m2 under 65 years old individuals. RESULTS: There was no significant difference of measured REE between groups according to smoking habits(p>0.05). In the older group(> or =65 years old), REE was lower compared to the younger groups(<65 years old)(p<0.05). In the obese group(body mass index>27kg/m2) measured REE was higher than the normal weight group(BMI<27kg/m2)(p<0.05). Among 108 individuals under 65 years old, other equation except for Fleish equation and Robertson and Reid equation were inaccurate when applied to the obese group. CONCLUSIONS: These commonly used prediction equations tend to overestimate the REE in obese individuals, and the best estimates for the obese seem to be derived from the Fleish and Robertson and Reid equations.
Adult ; Aged ; Body Mass Index ; Calorimetry ; Calorimetry, Indirect* ; Energy Intake ; Energy Metabolism* ; Humans ; Internal Medicine ; Obesity ; Smoke ; Smoking

Foreign bodies, such as surgical sponges or drains, are sometimes retained after surgical procedures.1 Retention of a drain in the breast tissue postoperatively is an unusual complication. This report describes two cases of characteristic sonographic findings related to retained silastic drains following breast surgery.
*Ultrasonography, Mammary ; Silicones ; Postoperative Complications/*diagnosis/radiography/ultrasonography ; *Mammography ; Humans ; Foreign Bodies/*diagnosis/radiography/ultrasonography ; Female ; Drainage/*instrumentation ; Dimethylpolysiloxanes ; Adult

PURPOSE: To evaluate the sonographic, mammographic and MRI features of pregnancy-associated breast cancer with the major focus on the sonographic benefit in a diagnosis of pregnancy associated breast cancer. MATERIALS AND METHODS: From 1998 to 2002, sonography was performed on a total 7 patients (age 23 to 38 years), who were pathologically diagnosed with breast cancer during pregnancy. Six of those patients underwent mammography. Five patients underwent a breast MRI, preoperatively. The radiological findings were evaluated retrospectively. Six patients underwent surgery and 1 patient underwent a core biopsy and chemotherapy. The histological, nuclear grading and pathological staging were evaluated. RESULTS: The sonographic findings showed a mass with irregular shapes (n=6), irregular margins (n=6), a non-parallel orientation (n=5), complex echo patterns (n=5). Associated findings could be observed in 3 patients, including Cooper's ligament thickening (n=2), edema (n=2), skin thickening (n=1) and axillary lymphadenopathy (n=3). The sonographic findings were positive and showed masses in 6 patients. All the patients had a dense breast in mammography. The mammographic findings included masses (n=4), masses with microcalcifications (n=2), masses with axillary lymphadenopathy (n=3), calcifications alone (n=1), an asymmetric density alone (n=1), extremely dense breasts with negative findings (n=2). A breast MRI showed an irregular shaped mass (n=4) with a rim-like enhancement (n=3), linear ductal enhancement without a mass (n= 1), and the time intensity cure revealed the typical pattern and level of enhancement in the carcinoma. CONCLUSION: Sonography is a valuable tool for diagnosing pregnancy-associated breast cancer. However, mammography should be performed if there is a suspicious lesion on sonography in order to confirm the pregnancy-associated breast cancer. Mammography has a lower sensitivity during pregnancy due to the physiologic changes in the breasts. However, calcifications and associated findings are helpful in confirming pregnancy-associated breast cancer. physicians should not consider a rapidly growing lump in the breast during pregnancy to be benign and should perform radiological examinations and imaging-guided biopsies.
Biopsy ; Breast Neoplasms* ; Breast* ; Diagnosis ; Drug Therapy ; Edema ; Humans ; Ligaments ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Mammography ; Pregnancy ; Retrospective Studies ; Skin ; Ultrasonography

BACKGROUND: Although occupational asthma is defined as a reversible airway obstruction causally related to exposure in the working environment, many occupational asthmatics complain of asthmatic symptoms despite avoidance of the causative agent. Subjects and methods. Twenty-nine patients with occupational asthma who had been confirmed by specific bronchial challenge with reactive dye or isocyanates and had avoided the causative agent for at least 6 months were included in this study. A questionnaire about asthmatic symptoms and medication requirements, a lung functiontest, and a methacholine bronchial provocation test were performed. RESULTS: Asthmatic symptoms at follow-up were remitted in seven (41.2%) isocyanate-induced asthmatics, but none with reactive dye-induced asthma were remitted. At follow-up, the symptom-medication score and FEV1 were significantly improved in isocyanate-induced asthmatics than in those with reactive dye-induced asthma, but the geometric mean of PC20-methacholine was not different between the two groups. Among 17 isocyanate-induced asthmatics, a duration from symptom onset to avoidance was significantly shorter in the remission group than in the nonremission group, although the symptom-medication scores, FEV1 (% predictive value) and logPC20-methacholine at an initial diagnosis, and follow-up period defined as duration from avoidance to follow-up, showed no difference between the two groups. CONCLUSION: The outcome of occupational asthma may be determined by the causative agents and the duration from onset of asthmatic symptoms to avoidance.
Airway Obstruction ; Asthma ; Asthma, Occupational* ; Bronchial Provocation Tests ; Diagnosis ; Follow-Up Studies ; Humans ; Isocyanates ; Lung ; Methacholine Chloride ; Prognosis ; Surveys and Questionnaires

OBJECTIVE: The exact position of the lesion during the pallidotomy is critical to obtain the clinical improvement of parkinson's disease without damage to surrounding structure. Ventriculogrphy, CT(computed tomograpy) or MRI(magnetic resonance imaging) have been used to determine the initial coordinates of stereotactic target for pallidotomy. The goal of this study was to determine whether microelectrode recording significantly improves the neurophysiologic localization of the target obtained from MRI. METHODS: Twenty patients were studied. They underwent a unilateral pallidotomy. Leksell frame was applied and T1 axial images parallel to the AC-PC(anterior commissure-posterior commissure) plane using a 1.5 Tesla MRI with 3mm slice thickness were obtained. Anteroposterior coordinate of target was chosen at 2mm in front of the midcommissural point and lateral coordinate between 19 and 22mm from the midline. The vertical coordinate was calculated on coronal slice using a fast spin echo inversion recovery sequence(FSEIR) related to the position of the choroidal fissure and ranged over 4-5mm below the AC-PC plane. Confirmation of the anatomical target was done on axial slices using the same FSEIR sequence. Microrecording was done at the pallidum contralateral to the symptomatic side using an electrode with a tip diameter of 1nm diameter tip and 1.1-1.4 mOhm impedance at 1000Hz. Electrophysiologic localization of the target was also confirmed intraoperatively by macrostimulation. RESULTS: Microrecording techniques were reliable to define the transition from the base of the pallidum which was characterized by the disappearance of spike activity and by the change of the audible background activity. Signals from high amplitude neurons firing at 200-400Hz were recorded in the pallidal base. X, Y and Z coordinates of target obtained from the MRI were within 1mm from the X, Y, Z coordinates obtained with microrecording in 16 patients (80%), 15 patients(75%), 10 patients(50%) respectively. The difference of Y coordinate between on MRI and on microrecording was 4mm in only one patient. CONCLUSION: The MRI was accurate to localize the target within 1mm of the error from microrecording target in 70% of the patients. 4mm discrepancy was observed only once. We conclude that MRI alone can be used to determine the target for pallidotomy in most patients. However, microrecording technique can still be extremely valuable in patents with aberrant anatomy or unusual MRI coordinates. We also consider physiologic confirmation of the target using macrostimulation to be mandatory in all cases.
Choroid ; Electric Impedance ; Electrodes ; Fires ; Humans ; Magnetic Resonance Imaging* ; Microelectrodes ; Neurons ; Pallidotomy* ; Parkinson Disease*

BACKGROUND: Exercise can aggravate asthmatic symptoms in many patients with bronchial asthma. It is caused by that inhaled air bypasses nasal cavity and goes directly to the lower airways through open mouth dring exercise. Although the pathogenetic mechanisms of exercise-induced asthma(EIA) have not been clarified yet, there is evidence that chemical mediators, released from the inflammatory cells triggered by airway cooling or drying, might be responsible for induction of bronchoconstriction. However, it has been controversial which chemical mediators or cells are involved in such process. Objectiye . The aim of this study was to evaluate the role of activated mast cells in the pathogenesis of EIA and find out whether or not sulfidopeptide leukotrienes (LTC4/d4/E4) are involved in the exercise-induced bronchoconstriction. MATERIAL AND METHOD: Eleven asthmatics with documented exercise-induced bronchoconstriction and 10 control subjects were studied. Before and 6 hours after free running for 6 minutes, forced expiratory volume in 1 second (FEV,) and the concentrations of N- methylhistamine, LTE4, and creatinine in unine collected for 6 hours after exercise were determined. RESULT: Urinary concentrations of N-methylhistamine(mean+SE, ng/mg creatinine) of EIA patients before and after exercise were 159+40 and 450+75, respectively. Those of control subjects were 208+ 54 and 275+ 62, respectively. Uninary N-methylhistamine levels of EIA group increased significantly after exercise, while those of control group did not change. Urinary concentrations of LTE,(mean+SE, pg/mg creatinine) of EIA patients before and after exercise were 15.6 k2.6 and 22.2+5.8, respectively. Those of control subjects were 10.4+ 4.0, 18.2 +7.0, respectively. The concentrations of LTE4 in the urine samples collected before exerise revealed no difference between EIA and control subjects (p=0.07). There was no change after exercise in both groups. Percent fall of FEV, was 29.1+8.0% (mean+SD) in EIA group and 3.4 + 4.0% in control group, respectively. There was no correlation between reduction of FEV, and change in urinary concentrations of N-methyl-histmine after exercise. CONCLUSTION: Chemical mediators of activated mast cells may be involved in exercise-induced bronchoconstriction, but there is little evidence for enhanced sulfidopeptide leukotriene generation as assessed by urinary LTE4.
Asthma ; Asthma, Exercise-Induced* ; Bronchoconstriction ; Creatinine ; Forced Expiratory Volume ; Humans ; Leukotriene E4 ; Leukotrienes ; Mast Cells ; Mouth ; Nasal Cavity ; Running

BACKGROUND: Bronchial hbyperresponsiveness (BHR) is a key feature of asthma, and may precede the development of asthma. Genetically determined and acquired factors may contribute to development of BHR. OBJECTIVE: To evaluate expression of bronchial responsiveness to methacholine according to age, sex, smoking habit, and atopy in general population without bronchial asthma, a cross sectional study was performed. METHOD: A total of 1,190 general population who composed of 408 subjects with age less than 19 years (young age group), 621 subjects with age from 20 to 40 years (middle age group), and 161 subjects with age more than 41 years (old age group) were enrolled. Evaluations were made by a questionnaire, serum IgE level and skin prick test to common inhalant allergens, and methacholine bronchial provocation test (MBPT). Bronchial responsiveness were evaluated by positive rate of MBPT (PC,p-methacholine 4 25mg/ml), and slope of dose- response curve (slope, %fall of FEV, / log[last concentration of methacholine, mg/ml]). RESULT: Positive rate of MBPT was 11.0%, and slope (mean+SE) was 10.6+0.2 %/mg/ml. Postive rate of MBPT was more prevalent in the young age group than in middle and old age groups (19.6% vs. 6.6% vs. 6.2%, p<0.05), and slope was higher in young age group than in other groups (14.4+0.4 vs. 8.6+0.3 vs. 8.9+0.5 %/mg/ml, p<0.05). No significant differences in positive rate of MBPT and slope were noted according to sex in young and old age groups. However, in the middle age group, slope was higher in females than in males (9.5+0.4 vs. 7.9+ 0.3 %/mg/ml, p<0.05). No significant differences of slope was observed according to smoking habit in males of middle age group, but in males of old age group, the slope was higher in subjects with smoking habit than those without it (9.6+0.8 vs. 6.5+0.9 %/mg/ml, p<0.05). Significant relationship was observed between geometric value of serum IgE level and slope(r=0. 152, p=0.009). The postive rate of MBPT and slope were significantly higher in subjects with positive skin rea,ctivity to common inhalant allergens than those without it (14.3% vs. 8.6%, p ( 0.05; 11.8+0.4 vs. 9.8+0.3 %/mg/ml, p<0.05). The difference of bronchial responsiveness according to skin reactivity was observed in young and middle age groups, but not in old age group. CONCLUSION: Bronchial responsiveness to methacholine is significantly higher in children than in adults, in middle-aged females than in middle-aged males. Atopy and smoking may have a dif ferent role to determine the bronchial responsiveness depending upon age and sex.
Adult ; Allergens ; Asthma* ; Bronchial Provocation Tests ; Child ; Female ; Humans ; Immunoglobulin E ; Male ; Methacholine Chloride* ; Middle Aged ; Skin ; Smoke ; Smoking ; Surveys and Questionnaires

BACKGROUND: The role of cutaneous bacterial flora in eczematous dermatitis has been discussed for decades. Areas of active dermatitis in patients with atopic dermatitis(AD) are known to be heavily colonized with Staphylococcus aureus. The density of S. aureus is correlated with the severity of AD. S. aureus is considered to be an exacerbating factor in this disease. The bacterium interferes in the inflammatory process of atopic dermatitis in various ways, among which the ability to release superantigens in a high percentage of clinical isolates is of great importance. OBJECTIVE: The purpose of this study was to evaluate the microbiology of the skin of the patients with AD and non-atopic dermatitis(NAD). We compared bacterial colonization of AD with those of NAD and healthy controls(HC). METHODS: Cutaneous organisms were obtained using Tape method from the worst lesion and uninvolved forearm skin of 30 patients with AD, 25 patients with NAD and 30 individuals as HC. Bacterial growth was examined in aerobic culture and the counts of colony forming unit(CFU) were estimated. The sensitivity to ten antibiotics of the bacteria isolated was also tested. RESULTS: 1.S. aureus colonizations of the eczematous skin were found in 19 of 30 AD patients(63%) and in 9 of 25 NAD patients(36%). The difference between the two groups was statistically significan t(p=0.076, alpha<0.1). 2.In AD patients, the frequencies of S. aureus colonizations revealed 63%(19 of 30) in the lesion and 60%(18 of 30) in uninvolved skin, which were significantly higher than 33%(10 of 30) of HC(p<0.05). 3.The frequency of S. aureus colonizations in the lesions of NAD patients revealed 36%, which was not significantly higher than 33% of HC(p=0.836). 4.Coagulase negative strains of staphylococcus were found in 20 of 30 HC(66%) and 17 of 25(68%) uninvolved skin of NAD patients(68%) compared with 12 of 30 uninvolved skin of with AD(40%). 5.In AD patients with positive nasal colonization with S. aureus, the frequencies of S. aureus colonization in the lesion and uninvolved skin were increased in significance compared with patients with negative nasal colonization(p<0.05). And total counts of CFU in the lesion and uninvolved skin of AD patients were significantly higher compared with HC(p<0.05). 6.Total counts of CFU correlated with severity of dermatitis. CONCLUSION: Colonization of S. aureus was significnatly increased in the skin of AD patients compared with healthy controls. As the severity of the AD lesions increased, the numbers of S. aureus isolated increased. These results support the role of S. aureus in the AD described in the previous reports. Tape method had the advantage of being inexpensive, quick and straightforward to prepare, easy for the clinician to use and was well tolerated by children. It is hoped that the result of this study and the availability of Tape method in the culture of bacteria of the skin will facilitate and promote investigations of pathophysiology and treatment of eczematous dermatitis as well as AD.
Anti-Bacterial Agents ; Bacteria ; Child ; Colon ; Dermatitis* ; Dermatitis, Atopic* ; Eczema ; Forearm ; Hope ; Humans ; NAD ; Skin ; Staphylococcus ; Staphylococcus aureus ; Superantigens

OBJECTIVES: In Korea, the BFHI (Baby-Friendly Hospital Initiative) committee organized in the Korean Committee for UNICEF in 1992, and continued to promote breastfeeding more than 10 years, we need reassess the designated hospitals and BFHI program. As a part of BFHI program, the committee continued to train health care personnels to carry out promotion of breastfeeding since 1994. The curriculum, contents and methods of the training course needs re-evaluation. METHODS: The breastfeeding rates in the BF (Baby-Friendly) hospitals and non-BF hospitals are compared. Changes of the breastfeeding rate before and after designation in baby friendly hospitals are evaluated. The education program for the health care personnels to promote successful breastfeeding are evaluated. RESULTS: The exclusively breastfeeding rates during hospitalization are higher in the BF hospitals than non-BF hospitals (p=0.026). The self assessment scores higher in the BF hospitals than non-BF hospitals (41.3 vs 31.5, p=0.001). Average breastfeeding rate of BF hospitals maintained 3.9 years after accredition (52.65% vs 47.62%). Education program for the health care personnels were satisfied in 82.8%. The score increased from 9.24 before the education course to 12.0 at 1 month after education (p=0.000) and remained as 12.19 at 3~6 months after education. CONCLUSION: This study revealed BFHI program improved breastfeeding rates and maintained high in the BF hospitals. Health care personnels who trained through education courses held by the Korean Committee for UNICEF assisted in the promotion of breastfeeding. This results can be used as a basic data for the planning of the breastfeeding promotion program in the future.
Breast Feeding ; Curriculum ; Delivery of Health Care ; Education ; Hospitalization ; Korea ; Self-Assessment ; United Nations

BACKGROUND: The nasopharyngeal temperature probe should be placed in the upper nasopharynx to reflect accurate core temperature. However, there have been no studies conducted to predict parameters for the optimal depth of the nasopharyngeal temperature probe. The purpose of this study was to examine the correlation between the optimal depth to the upper nasopharynx and the distance from the philtrum to the tragus and height. METHODS: Two hundred patients (100 females and 100 males) were enrolled in the study. The distance from the philtrum to the tragus along the facial curvature was measured, and the optimal depth from the nostril to the upper nasopharynx was evaluated using nasendoscopy. The relationships between the optimal depth to the upper nasopharynx and the distance from the philtrum to the tragus and height were examined. RESULTS: The distances from the philtrum to the tragus were 14.4 +/- 0.5 cm in females and 15.1 +/- 0.6 cm in males (P < 0.01). The depths from the nostril to the upper nasopharynx were 9.4 +/- 0.6 cm in females and 10.0 +/- 0.5 cm in males (P < 0.01). The correlation coefficients between the depth from the nostril to the upper nasopharynx and the distance to the tragus from the philtrum were 0.43 in females and 0.41 in males (P < 0.01). However, there were very weak correlations and no correlations between height and the depth from the nostril to the upper nasopharynx in females and males, respectively. CONCLUSIONS: The depth from the nostril to the upper nasopharynx is correlated weakly with the distance from the philtrum to the tragus. Although the distance from the philtrum to the tragus is not a good predicting parameter for the optimal depth of nasopharyngeal temperature probe placement, subtraction of 5 cm from the distance is helpful to estimate the optimal depth of the nasopharyngeal temperature probe.
Anesthesia ; Female ; Humans ; Lip* ; Male ; Nasopharynx